Provider Demographics
NPI:1548795644
Name:GERGUIS, WESSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WESSAM
Middle Name:
Last Name:GERGUIS
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 1:4923 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-6332
Mailing Address - Country:US
Mailing Address - Phone:813-368-9298
Mailing Address - Fax:
Practice Address - Street 1:5193 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1834
Practice Address - Country:US
Practice Address - Phone:352-688-6393
Practice Address - Fax:352-688-1113
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157775208100000X, 208VP0000X
PAMT212617208600000X
FL32446208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine