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General NPI Number Information
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NPI Number | 1265507628
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Entity Type | Individual
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Provider Name | MARC WEINBAUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 3002 SE 1ST AVE BUILDING 100
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City | OCALA
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State | FL
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Zip | 34471-0477
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Country | US
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Telephone | 352-732-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 SE 1ST AVE BUILDING 100
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City | OCALA
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State | FL
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Zip | 34471-0477
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Country | US
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Telephone | 352-732-0450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19584SC
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 01029010C
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME53120
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License Number State | FL
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