Healthcare Provider Details

I. General information

NPI: 1538628482
Provider Name (Legal Business Name): CHRISTOPHER WEEDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 37TH ST STE C101
VERO BEACH FL
32960-7301
US

IV. Provider business mailing address

777 37TH ST STE C101
VERO BEACH FL
32960-7301
US

V. Phone/Fax

Practice location:
  • Phone: 772-360-1997
  • Fax: 772-492-3541
Mailing address:
  • Phone: 772-360-1997
  • Fax: 772-492-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME166949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: