=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245416593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER WEISSGERBER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 07/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 N ORANGE AVE STE C
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-7613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-896-3091
-----------------------------------------------------
Fax | 407-896-2270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 N ORANGE AVE STE C
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-7613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-896-3091
-----------------------------------------------------
Fax | 407-896-2270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PETER WEISSGERBER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-896-3091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0043845
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------