Provider Demographics
NPI:1003000522
Name:WEIGAND, FREDERICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:WEIGAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1565 SAXON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5823
Mailing Address - Country:US
Mailing Address - Phone:386-917-7395
Mailing Address - Fax:386-532-7152
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-917-7395
Practice Address - Fax:386-532-7152
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME13473207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57592OtherUPIN
FL64212ZMedicare PIN