Provider Demographics
NPI:1316987076
Name:WEINSTEIN, DEBRA (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WORTH RD
Mailing Address - Street 2:#204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463
Mailing Address - Country:US
Mailing Address - Phone:561-968-7968
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:6056 BOYNTON BEACH BLVD
Practice Address - Street 2:# 145
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3584
Practice Address - Country:US
Practice Address - Phone:561-737-9227
Practice Address - Fax:561-737-8581
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59342700Medicaid
FL12871Medicare PIN
FL59342700Medicaid