MEDICARE: JEFFERY PRESTON WEITZNER M.D.

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	207R00000X	Internal Medicine Physician	ME25937	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110051050 GRP.CC5873	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	15317	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558395632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY PRESTON WEITZNER M.D.

Provider Business Mailing Address
First Line	:	2534 OAK ST.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4504
Country	:	US
Telephone Number	:	904-388-1970
Fax Number	:	904-387-4122

Provider Business Practice Location Address
First Line	:	2534 OAK ST.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4504
Country	:	US
Telephone Number	:	904-388-1970
Fax Number	:	904-387-4122

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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