Provider Demographics
NPI:1588682942
Name:WENGER, KENT NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:NORMAN
Last Name:WENGER
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 1:310 NW 76TH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1593
Mailing Address - Country:US
Mailing Address - Phone:352-333-1109
Mailing Address - Fax:352-331-6323
Practice Address - Street 1:310 NW 76TH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1593
Practice Address - Country:US
Practice Address - Phone:352-333-1109
Practice Address - Fax:352-331-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 865592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01545Other01545
FL01545OtherBC/BS
FL23176200Medicaid
FLO1545YMedicare ID - Type Unspecified
FL01545ZMedicare PIN
FL23176200Medicaid