Provider Demographics
NPI:1093980914
Name:SHERWOOD A. WEISMAN, D.P.M., P.A.
Entity Type:Organization
Organization Name:SHERWOOD A. WEISMAN, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERWOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-668-5744
Mailing Address - Street 1:75 FOX RIDGE CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2701
Mailing Address - Country:US
Mailing Address - Phone:386-668-5744
Mailing Address - Fax:
Practice Address - Street 1:75 FOX RIDGE CT
Practice Address - Street 2:SUITE E
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2701
Practice Address - Country:US
Practice Address - Phone:386-668-5744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0687332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041091800Medicaid
FL0670560002Medicare NSC
FL87261Medicare PIN
FLT85766Medicare UPIN