Provider Demographics
NPI:1013980077
Name:WEITMAN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2007 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6501
Mailing Address - Country:US
Mailing Address - Phone:561-420-8555
Mailing Address - Fax:888-442-6078
Practice Address - Street 1:1770 NE MIAMI GARDENS DR
Practice Address - Street 2:UNIT 1
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-5301
Practice Address - Country:US
Practice Address - Phone:305-949-4141
Practice Address - Fax:305-949-8090
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME46324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080157826Medicaid
FL080157826Medicaid
FL02303WMedicare PIN