Healthcare Provider Details

I. General information

NPI: 1801965496
Provider Name (Legal Business Name): EDMUND CHARLES WEIDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SECOND AVENUE NORTH SUITE 205
NAPLES FL
34102-5701
US

IV. Provider business mailing address

700 SECOND AVENUE NORTH SUITE 205
NAPLES FL
34102-5701
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-5400
  • Fax: 239-263-6661
Mailing address:
  • Phone: 239-263-5400
  • Fax: 239-263-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0038533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: