Provider Demographics
NPI:1205945201
Name:WEISSGERBER, PETER W (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:WEISSGERBER
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 1:3000 N ORANGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7613
Mailing Address - Country:US
Mailing Address - Phone:407-896-3091
Mailing Address - Fax:407-896-2270
Practice Address - Street 1:3000 N ORANGE AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7613
Practice Address - Country:US
Practice Address - Phone:407-896-3091
Practice Address - Fax:407-896-2270
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043932100Medicaid
FLME0043845OtherLICENSE
FLME0043845OtherLICENSE
FLD20743Medicare UPIN
FL02438XMedicare PIN