Provider Demographics
NPI:1598705188
Name:WEITZNER, BRADLEY SKLAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SKLAR
Last Name:WEITZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 VERSAILLES ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6900
Mailing Address - Country:US
Mailing Address - Phone:941-365-0770
Mailing Address - Fax:941-955-4536
Practice Address - Street 1:1945 VERSAILLES ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-365-0770
Practice Address - Fax:941-955-4536
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89997207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56359OtherBLUE CROSS OF FLORDIA
FLP00390130OtherRAILROAD MEDICARE PTAN
FL493662OtherAETNA
FL493662OtherAETNA
FLP00390130OtherRAILROAD MEDICARE PTAN