Provider Demographics
NPI:1053695312
Name:WELLMED MEDICAL MANAGEMENT OF FLORIDA, INC.
Entity type:Organization
Organization Name:WELLMED MEDICAL MANAGEMENT OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAPIER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:210-617-4706
Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1219
Mailing Address - Country:US
Mailing Address - Phone:210-877-7570
Mailing Address - Fax:210-641-2235
Practice Address - Street 1:591 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4202
Practice Address - Country:US
Practice Address - Phone:210-877-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty