Healthcare Provider Details

I. General information

NPI: 1295949758
Provider Name (Legal Business Name): RONALD WIEWORA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 DATURA ST SUITE 401
WEST PALM BEACH FL
33401-5414
US

IV. Provider business mailing address

324 DATURA ST SUITE 401
WEST PALM BEACH FL
33401-5414
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-1270
  • Fax: 561-802-3968
Mailing address:
  • Phone: 561-659-1270
  • Fax: 561-802-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 39948
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME39948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: