Provider Demographics
NPI:1275505208
Name:WEDEMEYER, DONALD C (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:C
Last Name:WEDEMEYER
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 232
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-0232
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-1974
Practice Address - Street 1:37920 MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4323
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:352-567-0218
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256368100Medicaid
FL44628ZMedicare ID - Type Unspecified
FL44628ZMedicare PIN
FL44628ZMedicare Oscar/Certification
G52846Medicare UPIN