MEDICARE: GILBERT WEISMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	OS0002452	FL

General Provider Information

NPI Number	:	1366697062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT WEISMAN D.O.

Provider Business Mailing Address
First Line	:	134 PORTO VECCHIO WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-6223
Country	:	US
Telephone Number	:	561-630-9945
Fax Number	:	425-940-4803

Provider Business Practice Location Address
First Line	:	134 PORTO VECCHIO WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-6223
Country	:	US
Telephone Number	:	561-630-9945
Fax Number	:	425-940-4803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	11/21/2008

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