WIDDLER DESHOMMES MD
NPI 1376172015
General Practice in Mount Dora, FL

Q: What is Widdler Deshommes's NPI number?

The NPI number for Widdler Deshommes is 1376172015. It was assigned to this individual provider in the NPPES registry on April 4, 2020.

Q: What is Widdler Deshommes's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Widdler Deshommes was last updated on March 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 04, 2020PECOS Enrolled

4601 N HIGHWAY 19A, MOUNT DORA, FL 32757(352) 290-8718 Get Directions Write a Review

NPPES record last updated: March 8, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 8, 2024, Feb 6, 2024, Jul 21, 2022 and 1 more (4 updates tracked since 2020).

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About Widdler Deshommes Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WIDDLER DESHOMMES MD (NPI 1376172015) is an individual general practice provider in Mount Dora, Florida, licensed in Florida (ACN1610) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1376172015

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameWIDDLER DESHOMMESCredential: MD

Location Address4601 N HIGHWAY 19AMount Dora, FL 32757-2039

Mailing Address550 Rouzer StApopka, FL 32712-3650 · (407) 575-0943

Phone(352) 290-8718

Sole ProprietorNo

Enumeration DateApril 4, 2020

Last NPPES UpdateMarch 8, 20244 updates tracked since enumeration

NPPES CertifiedMarch 8, 2024

✔ NPI 1376172015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Licenses✔ Licensed in FL · ACN1610✔ Licensed in PR · 023661

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedPhysician AssistantTaxonomy 363A00000X · License 000229-P.A (PR), 8363 (AZ), TPPA363 (FL)

4601 N HIGHWAY 19A, Mount Dora, FL 32757

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Secondary Practice Locations 3

Location 14540 E Baseline Rd Ste 105Mesa, AZ 85206-4616 · Phone (480) 272-8944 · Fax (480) 237-5682

Location 2425 S Hunt Club Blvd Ste 201Apopka, FL 32703-2428 · Phone (407) 304-9337

Location 355 Calle PalmaArecibo, PR 00612-4526 · Phone (787) 650-1030

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Widdler Deshommes Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SAMUEL JOSEPH PA-C, MD

Physician Assistant