Healthcare Provider Details

I. General information

NPI: 1104853811
Provider Name (Legal Business Name): KENT RAY WEHMEIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14135 BALLANTYNE CORPORATE PL STE 225
CHARLOTTE NC
28277-3871
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-2930
  • Fax:
Mailing address:
  • Phone: 980-302-7590
  • Fax: 980-302-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME99193
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2022-02354
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: