Provider Demographics
NPI:1588668016
Name:WINGERT, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:WINGERT
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 1:1003 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3601
Mailing Address - Country:US
Mailing Address - Phone:239-574-4600
Mailing Address - Fax:239-574-2621
Practice Address - Street 1:1003 DEL PRADO BLVD S
Practice Address - Street 2:SUITE #101
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3601
Practice Address - Country:US
Practice Address - Phone:239-574-4600
Practice Address - Fax:239-574-2621
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2017-08-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLME0034827207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038424100Medicaid
FL038424100Medicaid
D54449Medicare UPIN