Provider Demographics
NPI:1336119080
Name:POOLE, WAYNE F (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:F
Last Name:POOLE
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 1:715 SE 36TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8716
Mailing Address - Country:US
Mailing Address - Phone:352-804-7786
Mailing Address - Fax:
Practice Address - Street 1:2230 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1391
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME758632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262482600Medicaid
FLV2597OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLG75198Medicare UPIN
FL61942XMedicare PIN
FL61942AMedicare PIN
FL262482600Medicaid
FL61942WMedicare PIN