Provider Demographics
NPI:1437151313
Name:VAN WERT, JOHN WEST (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WEST
Last Name:VAN WERT
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 1:460 VENTRIS LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5641
Mailing Address - Country:US
Mailing Address - Phone:321-397-1212
Mailing Address - Fax:321-397-1213
Practice Address - Street 1:531 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4421
Practice Address - Country:US
Practice Address - Phone:321-397-1212
Practice Address - Fax:321-397-1213
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048316800Medicaid
FL04942Medicare ID - Type Unspecified