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Individual

EUGENE E WENTHE JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1223 GATEWAY DR STE 1E, MELBOURNE, FL 32901-2607
(321) 725-4505
(321) 409-6823
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036061047
IL
207Q00000X
Family Medicine Physician
Primary
ME117071
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020057300
BLACK LUNG
IL
01
036061047
IL STATE LICENSE
IL
05
036061047
IL
01
054913
HEALTH ALLIANCE
IL
01
080098256
RR MEDICARE PIN
IL
01
08421024
BC/BS
IL
01
101343
HEALTHLINK
IL
01
133586700
ACS-OWCP
IL
01
14D0949277
CLIA
IL
01
170774
PERSONAL CARE
IL
01
6394P
CATERPILLAR
IL
01
CD7143
RR MEDICARE GROUP
IL
Enumeration date
08/09/2006
Last updated
10/31/2018
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