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General NPI Number Information
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NPI Number | 1164730289
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Entity Type | Individual
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Provider Name | IAN WETHERALL PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 455 PINELLAS ST SUITE 320
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City | CLEARWATER
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State | FL
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Zip | 33756-3354
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Country | US
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Telephone | 727-446-2273
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Fax | 727-441-4966
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Provider Business Mailing Address
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Address Line | 455 PINELLAS ST STE 320
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City | CLEARWATER
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State | FL
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Zip | 33756-3369
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Country | US
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Telephone | 727-446-2273
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Fax | 727-441-4966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9108763
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10004676A
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License Number State | IN
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