Individual
MR. IAN WETHERALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
455 PINELLAS ST, SUITE 320, CLEARWATER, FL 33756-3354
(727) 446-2273
(727) 441-4966
Mailing address
455 PINELLAS ST STE 320, CLEARWATER, FL 33756-3369
(727) 446-2273
(727) 441-4966
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10004676A
IN
363AS0400X
Surgical Physician Assistant
PA9108763
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015310600
—
FL
01
—
Y0S8R
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/23/2010
Last updated
01/14/2025
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