Provider Demographics
NPI:1104853811
Name:WEHMEIER, KENT RAY (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:RAY
Last Name:WEHMEIER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-7590
Mailing Address - Fax:980-302-7591
Practice Address - Street 1:8110 HEALTHCARE LOOP STE 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7069
Practice Address - Country:US
Practice Address - Phone:980-302-7590
Practice Address - Fax:980-302-7591
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99193207RE0101X
NC2022-02354207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA365380102AMedicaid
FL2785358-00Medicaid