MEDICARE: GARY VAN WERTMAN II DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	201101058	NC
2	207X00000X	Orthopaedic Surgery Physician	201101058	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083805006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY VAN WERTMAN II DO

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	910-332-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 COUNTRY CLUB RD STE 800
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-2404
Country	:	US
Telephone Number	:	910-939-5759
Fax Number	:	910-939-4951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	02/19/2025

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