Basic Information
| Provider Information | |||||||||
| NPI: | 1962758938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WECOWSKI | ||||||||
| FirstName: | JACEK | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 SE 17TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344719190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526902171 | ||||||||
| FaxNumber: | 3526906954 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SE MAGNOLIA EXT STE 205 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291800 | ||||||||
| FaxNumber: | 3526291888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2012 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | ME141977 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | HSE26199 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 50398 | KY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.