Basic Information
Provider Information
NPI: 1003000522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEIGAND
FirstName: FREDERICK
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1565 SAXON BLVD STE 102
Address2:  
City: DELTONA
State: FL
PostalCode: 327255823
CountryCode: US
TelephoneNumber: 3869177395
FaxNumber: 3865327152
Practice Location
Address1: 1565 SAXON BLVD
Address2: SUITE 102
City: DELTONA
State: FL
PostalCode: 327255876
CountryCode: US
TelephoneNumber: 3869177395
FaxNumber: 3865327152
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 01/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QA0505XME13473FLY Allopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine

ID Information
IDTypeStateIssuerDescription
D5759201FLUPINOTHER


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