Provider Demographics
NPI:1689620502
Name:WEINSTEIN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEINSTEIN
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:PO BOX 863997
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3997
Mailing Address - Country:US
Mailing Address - Phone:866-396-6418
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:160 NW 13TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4228
Practice Address - Country:US
Practice Address - Phone:786-243-8000
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00374148OtherRRMCR
FLP00374148OtherRAILROAD MEDICARE
FL94500OtherBCBS
FLD64718Medicare PIN
FL94500OtherBCBS