Provider Demographics
NPI:1366448615
Name:WURST, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:WURST
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 1:4408 DELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7492
Mailing Address - Country:US
Mailing Address - Phone:850-636-7000
Mailing Address - Fax:850-636-7072
Practice Address - Street 1:525 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5412
Practice Address - Country:US
Practice Address - Phone:850-522-4485
Practice Address - Fax:850-914-6281
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME550572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18041OtherBCBS OF FL
FL376103700Medicaid
FL376103701Medicaid
FL376103702Medicaid
FL376103700Medicaid
FL376103702Medicaid
18041QMedicare ID - Type Unspecified
FL376103701Medicaid
FL376103700Medicaid
18041ZMedicare ID - Type Unspecified
18041UMedicare ID - Type Unspecified