Provider Demographics
NPI:1417324336
Name:STROH, WENDY ANN (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:STROH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:KOERTJE STROH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-273-7839
Mailing Address - Fax:352-273-8172
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0275
Practice Address - Country:US
Practice Address - Phone:352-273-7839
Practice Address - Fax:352-273-8172
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5311207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015759200Medicaid
FLII557ZMedicare PIN