Provider Demographics
NPI:1336147875
Name:WEIGLEY, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:WEIGLEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:685 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7853
Mailing Address - Country:US
Mailing Address - Phone:407-339-5959
Mailing Address - Fax:407-339-5951
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-339-5959
Practice Address - Fax:407-339-5951
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-02-22
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Provider Licenses
StateLicense IDTaxonomies
FLME0026614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58576Medicare UPIN
FL78898Medicare ID - Type Unspecified