Provider Demographics
NPI:1881684454
Name:WOESTE, JOHN THEODORE JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THEODORE
Last Name:WOESTE
Suffix:JR
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 1:6195 LAKE GRAY BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5891
Mailing Address - Country:US
Mailing Address - Phone:904-389-1010
Mailing Address - Fax:904-389-1082
Practice Address - Street 1:1375 ROBERTS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3210
Practice Address - Country:US
Practice Address - Phone:904-389-1010
Practice Address - Fax:904-270-2715
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64342207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373694600Medicaid
FL23094WMedicare PIN
FL373694600Medicaid