Provider Demographics
NPI:1659460962
Name:WASSEL, HARRY DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:DONALD
Last Name:WASSEL
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 1:6675 38TH AVE N
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1594
Mailing Address - Country:US
Mailing Address - Phone:727-343-4400
Mailing Address - Fax:727-343-4442
Practice Address - Street 1:6675 38TH AVE N
Practice Address - Street 2:SUITE 103A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1594
Practice Address - Country:US
Practice Address - Phone:727-343-4400
Practice Address - Fax:727-343-4442
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 12761207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE 15799Medicare UPIN
FL52674Medicare ID - Type UnspecifiedMEDICARE