Provider Demographics
NPI:1861465585
Name:OBERTI, WAYNE W (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:W
Last Name:OBERTI
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-338-2111
Mailing Address - Fax:352-338-7130
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-338-2111
Practice Address - Fax:352-338-7130
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040502207P00000X
FLME 37145207P00000X
FLME37145207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0399892-00Medicaid
FL039989200Medicaid
GA000675793HMedicaid
GA93BDHSHMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL15598JMedicare PIN
GA000675793HMedicaid
FL0399892-00Medicaid
D52660Medicare UPIN
GAD52660Medicare UPIN
FL15598KMedicare PIN