Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 86393 | GA |
Y | 2081S0010X | Sports Medicine | ME141148 | FL |
Y | 213ES0000X | Sports Medicine | ME141148 | FL |
NPI | 1396196101 |
---|---|
Provider Name | Dr. Martin Weaver |
First Address | Fort Lauderdale, FL 33308-3203 |
Second Address | Fort Lauderdale, FL 33308-3203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 31/08/2021 |