Provider Demographics
NPI:1770535205
Name:WEHR, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WEHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3407
Mailing Address - Country:US
Mailing Address - Phone:727-523-3254
Mailing Address - Fax:727-523-3251
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3407
Practice Address - Country:US
Practice Address - Phone:727-523-3254
Practice Address - Fax:727-523-3251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058371501Medicaid
FL14677Medicare PIN
FLF19947Medicare UPIN