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General NPI Number Information
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NPI Number | 1396196101
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Entity Type | Individual
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Provider Name | MARTIN WEAVER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 5400 N FEDERAL HWY STE 102
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3203
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Country | US
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Telephone | 954-866-9699
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 N FEDERAL HWY STE 102
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3203
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 86393
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME141148
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License Number State | FL
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