Healthcare Provider Details

I. General information

NPI: 1043645146
Provider Name (Legal Business Name): JEFFREY WEINHEIMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAKE ELLENOR DR
ORLANDO FL
32809-4615
US

IV. Provider business mailing address

6000 LAKE ELLENOR DR
ORLANDO FL
32809-4615
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-6196
  • Fax: 407-438-0840
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDOOS13485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS13485
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13485
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO3376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: