MEDICARE: DR. GRETTEL WENTLING 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	208600000X	Surgery Physician	ME79605	FL

General Provider Information

NPI Number	:	1922577626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETTEL WENTLING MD

Provider Business Mailing Address
First Line	:	7915 TURNSTONE CIR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 TURNSTONE CIR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2358
Country	:	US
Telephone Number	:	904-993-1898
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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