MEDICARE: DR. GABRIEL MARK WERDER MD

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	2085R0204X	Vascular & Interventional Radiology Physician	0101253202	VA
2	2085R0204X	Vascular & Interventional Radiology Physician	24855	WV
3	2085R0202X	Diagnostic Radiology Physician	ME126311	FL
4	2085R0202X	Diagnostic Radiology Physician	24855	WV
5	2085R0202X	Diagnostic Radiology Physician	0101253202	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	LQ097	OTHER	FL	FL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10103500	OTHER	VA	SENTARA HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	W3341	OTHER	FL	HFMG
4	10106888	OTHER	VA	SENTARA HEALTH PLAN
6	9545845	OTHER	VA	AETNA HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336353978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL MARK WERDER MD

Provider Business Mailing Address
First Line	:	373 PEREGRINE DR
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4744
Country	:	US
Telephone Number	:	248-703-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 GATEWAY DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2607
Country	:	US
Telephone Number	:	321-549-0677
Fax Number	:	321-722-2432

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/02/2026

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Directions to “ DR. GABRIEL MARK WERDER MD” Practice Location

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