Individual
WAYNE ALBERT WIVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6716 NW 11TH PL STE 200, GAINESVILLE, FL 32605-4201
(352) 331-9729
(352) 331-0136
Mailing address
6716 NW 11TH PL STE 200, GAINESVILLE, FL 32605-4201
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
81971
MA
2085R0202X
Diagnostic Radiology Physician
Primary
ME145109
FL
2085R0204X
Vascular & Interventional Radiology Physician
81971
MA
2085R0204X
Vascular & Interventional Radiology Physician
ME145109
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106807000
—
FL
01
—
7CZ1B
BCBS
FL
01
—
MQ511
MEDICARE
FL
01
—
MQ512
MEDICARE
FL
Enumeration date
11/22/2005
Last updated
03/10/2022
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