Provider Demographics
NPI:1316903917
Name:WEISBAUM, GEOFFREY S (DO)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:S
Last Name:WEISBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 E BROADVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1916
Mailing Address - Country:US
Mailing Address - Phone:305-431-7053
Mailing Address - Fax:
Practice Address - Street 1:9450 E BROADVIEW DR
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-1916
Practice Address - Country:US
Practice Address - Phone:305-431-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0004181207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277364300Medicaid
FL82556OtherBCBS OF FL
FL82556XMedicare PIN
FL82556OtherBCBS OF FL