Healthcare Provider Details

I. General information

NPI: 1003000522
Provider Name (Legal Business Name): FREDERICK J WEIGAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SAXON BLVD SUITE 102
DELTONA FL
32725-5876
US

IV. Provider business mailing address

1565 SAXON BLVD STE 102
DELTONA FL
32725-5823
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-7395
  • Fax: 386-532-7152
Mailing address:
  • Phone: 386-917-7395
  • Fax: 386-532-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME13473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: