Provider Demographics
NPI:1568411577
Name:WEINBERGER, JOEL MARC (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MARC
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4100
Mailing Address - Country:US
Mailing Address - Phone:407-933-2522
Mailing Address - Fax:407-932-0215
Practice Address - Street 1:720 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4100
Practice Address - Country:US
Practice Address - Phone:407-933-2522
Practice Address - Fax:407-932-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 4999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042205300Medicaid
FL042205300Medicaid
FLD60725Medicare UPIN