Provider Demographics
NPI:1801898655
Name:WENGER, JEFFREY STUART (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STUART
Last Name:WENGER
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 1:1117 N OLIVE AVE
Mailing Address - Street 2:STE. 203
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3520
Mailing Address - Country:US
Mailing Address - Phone:561-802-9050
Mailing Address - Fax:561-802-9059
Practice Address - Street 1:1117 N OLIVE AVE
Practice Address - Street 2:STE. 203
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3520
Practice Address - Country:US
Practice Address - Phone:561-802-9050
Practice Address - Fax:561-802-9059
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58377207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064800100Medicaid
FLE70689Medicare UPIN
FL064800100Medicaid