Provider Demographics
NPI:1255692786
Name:WEINMAN, SUSAN LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNNE
Last Name:WEINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 SAUMS DR
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5034
Mailing Address - Country:US
Mailing Address - Phone:239-656-1362
Mailing Address - Fax:
Practice Address - Street 1:4138 SAUMS DR
Practice Address - Street 2:
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-5034
Practice Address - Country:US
Practice Address - Phone:239-656-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19209208000000X
FLME 92491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics