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Organization

JONATHAN R. WEISER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. WANDA DITTHARDT (OFFICE MANAGER)
(954) 964-4113
Entity
Organization

Contact information

Practice address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 964-4113
(954) 963-8121
Mailing address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 964-4113
(954) 963-8121

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME62894
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17993
BLUE CROSS BLUE SHIELD
FL
01
208183
AVMED
FL
Enumeration date
03/13/2015
Last updated
03/13/2015
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