Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS13485 | FL |
N | 207Q00000X | Family Doctor | UO3376 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | DOOS13485 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS13485 | FL |
NPI | 1043645146 |
---|---|
Provider Name | Dr. Jeffrey Weinheimer |
First Address | Orlando, FL 32809-4615 |
Second Address | Orlando, FL 32809-4615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2013 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS13485 | DO (01) | FL |