Provider Demographics
NPI:1053323527
Name:GABBARD, WESLEY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ALAN
Last Name:GABBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14134 NEPHRON LANE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-863-5418
Mailing Address - Fax:727-869-8626
Practice Address - Street 1:29296 US HWY 19N
Practice Address - Street 2:SUITE 4
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-784-8444
Practice Address - Fax:727-784-8445
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25328207P00000X, 207RN0300X
FLNE105493207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001335100Medicaid
FLH4704CN763ZMedicare UPIN
CN763ZMedicare PIN