Provider Demographics
NPI:1972548139
Name:WENDT, FREDERICK CARL (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CARL
Last Name:WENDT
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:PO BOX 21626
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33742-1626
Mailing Address - Country:US
Mailing Address - Phone:832-723-6714
Mailing Address - Fax:850-969-2910
Practice Address - Street 1:8333 NORTH DAVIS HWY
Practice Address - Street 2:MEDICAL CENTER CLINIC/RADIOLOGY DEP
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-474-8688
Practice Address - Fax:850-969-2910
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME828692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264142900Medicaid
FLH53941Medicare UPIN
FL264142900Medicaid