Individual
JOHN WIDERGREN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 215-7720
Mailing address
1859 SALT MYRTLE LN, ORANGE PARK, FL 32003-7062
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
41739-020
WI
Other
Enumeration date
01/25/2006
Last updated
07/08/2007
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