Healthcare Provider Details

I. General information

NPI: 1366697062
Provider Name (Legal Business Name): GILBERT WEISMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 PORTO VECCHIO WAY
PALM BEACH GARDENS FL
33418-6223
US

IV. Provider business mailing address

134 PORTO VECCHIO WAY
PALM BEACH GARDENS FL
33418-6223
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-9945
  • Fax: 425-940-4803
Mailing address:
  • Phone: 561-630-9945
  • Fax: 425-940-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS0002452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: