Provider Demographics
NPI:1053342386
Name:WEINTRAUB, MARK P (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:WEINTRAUB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:941-794-2251
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-04-26
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Provider Licenses
StateLicense IDTaxonomies
FLME0068491208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09134OtherUNIVERSAL
FLP01040599OtherRAILROAD MCR
FL1193517OtherWELLCARE
FLP102261OtherFREEDOM HEALTH
FL27451OtherBCBS FL
FL012776600Medicaid
FL353795OtherAVMED
FL5103435OtherAETNA
FLP939415OtherOPTIMUM
FL1193517OtherWELLCARE
FL5103435OtherAETNA
FL27451OtherBCBS FL