1871677708 NPI number — RANDALL L WEISEL, DDS, PA

Table of content: ELLEN HOLLYWOOD FNP-BC (NPI 1619365004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871677708 NPI number — RANDALL L WEISEL, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALL L WEISEL, DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871677708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 E BAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-536-5787
Provider Business Mailing Address Fax Number:
727-530-9630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 E BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-536-5787
Provider Business Practice Location Address Fax Number:
727-530-9630
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEISEL
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-536-5787

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DN0010195 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15140 . This is a "FORTIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 60453 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9676 . This is a "SAFEGUARD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4010 . This is a "COMPBENEFITS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 604999 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 215754 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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