Provider Demographics
NPI:1043534670
Name:MARK E. WEIGLEY, M.D., P.A.
Entity Type:Organization
Organization Name:MARK E. WEIGLEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WEIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-339-5959
Mailing Address - Street 1:685 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7853
Mailing Address - Country:US
Mailing Address - Phone:407-339-5959
Mailing Address - Fax:407-339-5951
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-339-5959
Practice Address - Fax:407-339-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME002614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58576Medicare UPIN