=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013980077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK WEITMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 04/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1770 NE MIAMI GARDENS DR UNIT 1
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-949-4141
-----------------------------------------------------
Fax | 305-949-8090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2007 PALM BEACH LAKES BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-420-8555
-----------------------------------------------------
Fax | 888-442-6078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME46324
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------