Provider Demographics
NPI:1962758938
Name:WECOWSKI, JACEK ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JACEK
Middle Name:ROBERT
Last Name:WECOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9190
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:1500 SE MAGNOLIA EXT STE 205
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4461
Practice Address - Country:US
Practice Address - Phone:352-629-1800
Practice Address - Fax:352-629-1888
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1419772086X0206X
FLHSE26199208600000X
KY503982086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care