Active NPI
John Widergren
- Surgery Physician
- Jacksonville, FL
National Provider Identifier
1144290628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 41739-020
- Practice address
- 2080 Child St
Jacksonville, FL 32214-5005 - Phone
- (904) 215-7720
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 41739-020 | WI | Primary |
Addresses
Primary practice location
2080 Child St
Jacksonville, FL 32214-5005
Mailing address
1859 Salt Myrtle LN
Orange Park, FL 32003-7062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41739-020 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1144290628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1859 SALT MYRTLE LN",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320037062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 CHILD ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322145005",
"telephone_number": "904-215-7720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDERGREN",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "41739-020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.