Provider Demographics
NPI:1063778256
Name:WELBERN, VANESSA RENEE (MD)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RENEE
Last Name:WELBERN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1613 N HARRISON PARKWAY
Mailing Address - Street 2:MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:OCALA REGIONAL MEDICAL CENTER
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-401-1000
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123885282N00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital