Provider Demographics
NPI:1952303935
Name:WEPPELMANN, BURKHARD (MD)
Entity Type:Individual
Prefix:
First Name:BURKHARD
Middle Name:
Last Name:WEPPELMANN
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:12109 COUNTY ROAD 103
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2951
Practice Address - Country:US
Practice Address - Phone:352-205-8981
Practice Address - Fax:352-391-6498
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME474422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11675OtherBCBSFL
FL11675OtherBCBSFL
FL052695900Medicaid
FL11675SMedicare PIN
FLC79069Medicare UPIN