MEDICARE: DR. RAYMOND LOUIS WEIAND D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MBO48543NJ	NJ
2	207X00000X	Orthopaedic Surgery Physician	OS14386	FL
3	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	OS14386	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871537027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND LOUIS WEIAND D.O.

Provider Business Mailing Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2801
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-586-1910
Fax Number	:	386-586-1939

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2801
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-586-1910
Fax Number	:	386-586-1939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	06/02/2020

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Directions to “ DR. RAYMOND LOUIS WEIAND D.O.” Practice Location

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