MEDICARE: DR. JOSEPH WEATHERLY 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	207Q00000X	Family Medicine Physician	OS12554	FL
2	207Q00000X	Family Medicine Physician	UO3136	FL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417392697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WEATHERLY D.O.

Provider Business Mailing Address
First Line	:	5860 RANCH LAKE BLVD
Second Line	:	SUITE 200
City	:	BRADENTON
State	:	FL
Zip	:	34202-3708
Country	:	US
Telephone Number	:	941-388-8997
Fax Number	:	941-306-5876

Provider Business Practice Location Address
First Line	:	5860 RANCH LAKE BLVD
Second Line	:	SUITE 200
City	:	BRADENTON
State	:	FL
Zip	:	34202-3708
Country	:	US
Telephone Number	:	941-388-8997
Fax Number	:	941-306-5876

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

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	09/09/2015

Similar Medicare Providers

1316948318 — MR. IRWIN BECKER MD
Practice Location Address:

5860 RANCH LAKE BLVD , SUITE 200
BRADENTON, FL
34202-3708

Practice Phone: 941-388-8997
Practice Fax: 941-306-5876

1568409407 — DR. MATTHEW BR NESSETTI MD PHD
Practice Location Address:

5860 RANCH LAKE BLVD , SUITE 200
BRADENTON, FL
34202-3708

Practice Phone: 941-388-8997
Practice Fax: 941-306-5876

1518152081 — MR. SANJEEV JOSEPH MSPT
Practice Location Address:

5860 RANCH LAKE BLVD , SUITE A
BRADENTON, FL
34202-3708

Practice Phone: 941-417-8300
Practice Fax: 941-417-8301

1245409655 — DR. DORIS KATHERINE RAMIREZ NESSETTI MD
Practice Location Address:

5860 RANCH LAKE BLVD , SUITE 200
BRADENTON, FL
34202-3708

Practice Phone: 941-388-8997
Practice Fax: 941-306-5876

1942572037 — WAL-MART STORES EAST LP
Practice Location Address:

5810 RANCH LAKE BLVD
BRADENTON, FL
34202-3708

Practice Phone: 941-799-5545
Practice Fax:

1386917490 — WAL-MART STORES EAST LP
Practice Location Address:

5810 RANCH LAKE BLVD
BRADENTON, FL
34202-3708

Practice Phone: 941-756-7975
Practice Fax:

Directions to “ DR. JOSEPH WEATHERLY D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.