Provider Demographics
NPI:1902837867
Name:WERNICKI, PETER GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GERARD
Last Name:WERNICKI
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 1:787 37TH ST STE E200
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7306
Mailing Address - Country:US
Mailing Address - Phone:772-978-7808
Mailing Address - Fax:772-978-9320
Practice Address - Street 1:787 37TH ST STE E200
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7306
Practice Address - Country:US
Practice Address - Phone:772-978-7808
Practice Address - Fax:772-978-9320
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0057400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0634280000Medicaid
200035314OtherRAILROAD MEDICARE
1276130001OtherPALMETTO
650938033OtherCHAMPUS
FL0634280000Medicaid
FLE95263Medicare UPIN