Healthcare Provider Details

I. General information

NPI: 1871835256
Provider Name (Legal Business Name): DOUGLAS WEILAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 03/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 LANDMARK DR
CLEARWATER FL
33761-1909
US

IV. Provider business mailing address

3273 LANDMARK DR
CLEARWATER FL
33761-1909
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-6330
  • Fax: 727-787-6343
Mailing address:
  • Phone: 727-787-6330
  • Fax: 727-787-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME 55424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: