Provider Demographics
NPI:1528018017
Name:WERT, DOUGLAS ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name: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 1:4648 GRAND BLVD
Mailing Address - Street 2:FLORIDA MEDICAL CENTER DOUGLAS WERT MD
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-842-7397
Mailing Address - Fax:727-842-7790
Practice Address - Street 1:4648 GRAND BOULEVARD
Practice Address - Street 2:FLORIDA MEDICAL CENTER DOUGLAS WERT MD
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:727-842-7397
Practice Address - Fax:727-842-7790
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03840Medicare ID - Type Unspecified
D50848Medicare UPIN