Individual
PHILLIP ALEX WIMPELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2720 US HIGHWAY 1 S, STE B, ST AUGUSTINE, FL 32086-6301
(904) 827-0078
(904) 827-0140
Mailing address
2720 US HIGHWAY 1 S, STE B, ST AUGUSTINE, FL 32086-6301
(904) 827-0078
(904) 827-0140
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9101929
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291914100
—
FL
01
—
P00295658
RR MEDICARE
FL
Enumeration date
10/02/2006
Last updated
01/31/2013
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