Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 61001 | FL |
NPI | 1134139447 |
---|---|
Provider Name | Dr. Stephen William Wener |
First Address | Fort Myers, FL 33916-9413 |
Second Address | Fort Myers, FL 33916-9413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | FL |