Provider Demographics
NPI:1063663615
Name:NEGRON, WILFREDO ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:ALEXIS
Last Name:NEGRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 REYNOLDS ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6010
Mailing Address - Country:US
Mailing Address - Phone:912-355-7303
Mailing Address - Fax:
Practice Address - Street 1:5354 REYNOLDS ST STE 304
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6010
Practice Address - Country:US
Practice Address - Phone:912-355-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144816207V00000X
GA70292207V00000X, 207V00000X
NMMD20110644207V00000X
FLME106394207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003163466AMedicaid