Provider Demographics
NPI:1699381996
Name:WEISSBLUTH, ELLIOT SOL
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:SOL
Last Name:WEISSBLUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 S FEDERAL HWY STE 380
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7335
Mailing Address - Country:US
Mailing Address - Phone:312-925-4400
Mailing Address - Fax:
Practice Address - Street 1:162 N OUTLOOK TRAIL
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59720
Practice Address - Country:US
Practice Address - Phone:312-925-4400
Practice Address - Fax:312-925-4400
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCOMPLETING207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services