Healthcare Provider Details

I. General information

NPI: 1245242973
Provider Name (Legal Business Name): RICHARD A WEINSTOCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 BURNS RD SUITE 104
PALM BEACH GARDENS FL
33410-4353
US

IV. Provider business mailing address

900 NW 13TH ST SUITE 206
BOCA RATON FL
33486-2335
US

V. Phone/Fax

Practice location:
  • Phone: 561-691-4144
  • Fax: 561-625-6151
Mailing address:
  • Phone: 561-668-3267
  • Fax: 561-391-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME056006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: