Provider Demographics
NPI:1992787147
Name:WAELTZ, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WAELTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:10131 FOREST HILL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6109
Mailing Address - Country:US
Mailing Address - Phone:561-798-6600
Mailing Address - Fax:561-753-3328
Practice Address - Street 1:10131 FOREST HILL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6109
Practice Address - Country:US
Practice Address - Phone:561-798-6600
Practice Address - Fax:561-753-3328
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME67947207X00000X
FLME0067947207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378102000Medicaid
FLG11501Medicare UPIN
FL27223YMedicare PIN
FL27223YMedicare Oscar/Certification