Provider Demographics
NPI:1407832520
Name:WEARE, JOHN L JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:WEARE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91550 OVERSEAS HWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2506
Mailing Address - Country:US
Mailing Address - Phone:305-853-0558
Mailing Address - Fax:305-853-0744
Practice Address - Street 1:91550 OVERSEAS HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2506
Practice Address - Country:US
Practice Address - Phone:305-853-0558
Practice Address - Fax:305-853-0744
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370013101OtherRR MEDICARE
FL040320212Medicaid
FL08690Medicare PIN
FL08690Medicare PIN