MEDICARE: JACEK ROBERT WECOWSKI M.D.

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	2086X0206X	Surgical Oncology Physician	ME141977	FL
2	208600000X	Surgery Physician	HSE26199	FL
3	2086S0102X	Surgical Critical Care Physician	50398	KY

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

General Provider Information

NPI Number	:	1962758938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACEK ROBERT WECOWSKI M.D.

Provider Business Mailing Address
First Line	:	2405 SE 17TH ST STE 201
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-9190
Country	:	US
Telephone Number	:	352-690-2171
Fax Number	:	352-690-6954

Provider Business Practice Location Address
First Line	:	1500 SE MAGNOLIA EXT STE 205
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-4461
Country	:	US
Telephone Number	:	352-629-1800
Fax Number	:	352-629-1888

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

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	09/26/2019

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