Provider Demographics
NPI:1851450043
Name:WESTON FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:WESTON FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-349-3030
Mailing Address - Street 1:1604 TOWN CENTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3640
Mailing Address - Country:US
Mailing Address - Phone:954-349-3030
Mailing Address - Fax:954-349-9337
Practice Address - Street 1:1604 TOWN CENTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3640
Practice Address - Country:US
Practice Address - Phone:954-349-3030
Practice Address - Fax:954-349-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21662Medicare PIN