Provider Demographics
NPI:1073667689
Name:WEATHERFORD, GREGORY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:WEATHERFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4921
Mailing Address - Country:US
Mailing Address - Phone:561-734-8400
Mailing Address - Fax:561-732-8807
Practice Address - Street 1:505 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4921
Practice Address - Country:US
Practice Address - Phone:561-734-8400
Practice Address - Fax:561-732-8807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04487OtherBLUE CROSS BLUE SHIELD
D51033Medicare UPIN
FL04487OtherBLUE CROSS BLUE SHIELD
K1572Medicare ID - Type UnspecifiedGROUP NUMBER
080136104Medicare ID - Type UnspecifiedRAILROAD MEDICARE