Provider Demographics
NPI:1609847037
Name:WYMER, DAVID COLE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:COLE
Last Name:WYMER
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 1:14813 NW 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2009
Mailing Address - Country:US
Mailing Address - Phone:352-332-1907
Mailing Address - Fax:352-332-1907
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-374-6064
Practice Address - Fax:352-379-4180
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME830472085R0202X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263587900Medicaid
FL263587900Medicaid
E10302Medicare UPIN