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General NPI Number Information
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NPI Number | 1609053636
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Entity Type | Individual
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Provider Name | EDWARD ALAN WETZEL
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Gender | Male
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 612 S DEAN RD
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City | ORLANDO
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State | FL
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Zip | 32825-8100
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Country | US
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Telephone | 407-306-9488
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Fax | 407-306-9487
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Provider Business Mailing Address
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Address Line | 612 S DEAN RD
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City | ORLANDO
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State | FL
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Zip | 32825-8100
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Country | US
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Telephone | 407-306-9488
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Fax | 407-306-9487
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 3100-0602419
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License Number State | FL
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