Provider Demographics
NPI:1912378829
Name:GILA R WEINSTEIN MD LLC
Entity Type:Organization
Organization Name:GILA R WEINSTEIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-939-0480
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-939-0480
Mailing Address - Fax:561-939-5460
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-939-0480
Practice Address - Fax:561-939-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 124679208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty