1962428219 NPI number — ANNMARIE E WEEKES DO

Table of content: ANNMARIE E WEEKES DO (NPI 1962428219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962428219 NPI number — ANNMARIE E WEEKES DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKES
Provider First Name:
ANNMARIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1962428219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 HAMILTON PLACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33813-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-648-0377
Provider Business Mailing Address Fax Number:
863-648-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 OSPREY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTOW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33830-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-519-1416
Provider Business Practice Location Address Fax Number:
863-519-1427
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  OS6136 , 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: 80521 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com