Individual
WIDDLER DESHOMMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4601 N HIGHWAY 19A, MOUNT DORA, FL 32757-2039
(352) 290-8718
Mailing address
550 ROUZER ST, APOPKA, FL 32712-3650
(407) 575-0943
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
023661
PR
208D00000X
General Practice Physician
Primary
ACN1610
FL
363A00000X
Physician Assistant
000229-P.A
PR
363A00000X
Physician Assistant
8363
AZ
363A00000X
Physician Assistant
TPPA363
FL
Other
Enumeration date
04/04/2020
Last updated
03/08/2024
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