Provider Demographics
NPI:1063449643
Name:WESTERGARD, MARC (DOM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:WESTERGARD
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 BELCHER RD S
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1677
Mailing Address - Country:US
Mailing Address - Phone:727-507-7680
Mailing Address - Fax:
Practice Address - Street 1:13220 BELCHER RD S
Practice Address - Street 2:SUITE 8
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1677
Practice Address - Country:US
Practice Address - Phone:727-507-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist