Healthcare Provider Details

I. General information

NPI: 1407174923
Provider Name (Legal Business Name): DANIEL WUBNEH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W FAIRBANKS AVE
WINTER PARK FL
32789-4603
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 407-845-8356
  • Fax: 407-845-8357
Mailing address:
  • Phone: 772-778-8687
  • Fax: 772-794-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberUO1849
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS13336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: