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General NPI Number Information
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NPI Number | 1649299520
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Entity Type | Individual
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Provider Name | MARK JOHN WEHRUM D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 2415 N ORANGE AVE STE 402
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City | ORLANDO
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State | FL
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Zip | 32804
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Country | US
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Telephone | 407-622-0560
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Fax | 407-622-0563
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Provider Business Mailing Address
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Address Line | 2415 N ORANGE AVE STE 402
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City | ORLANDO
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State | FL
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Zip | 32804-5505
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Country | US
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Telephone | 407-622-0560
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Fax | 407-622-0563
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 200001021
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 8149327-1204
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | OS12635
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License Number State | FL
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