Provider Demographics
NPI:1609053636
Name:WETZEL, EDWARD ALAN
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:WETZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S DEAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8100
Mailing Address - Country:US
Mailing Address - Phone:407-306-9488
Mailing Address - Fax:407-306-9487
Practice Address - Street 1:612 S DEAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8100
Practice Address - Country:US
Practice Address - Phone:407-306-9488
Practice Address - Fax:407-306-9487
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3100-0602419347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle