Organization
A FOOT CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK E WEAVER DPM (PRESIDENT)
(239) 278-4448
Entity
Organization
Contact information
Practice address
1645 COLONIAL BLVD, FORT MYERS, FL 33907-1101
(239) 278-4448
(239) 939-1286
Mailing address
1645 COLONIAL BLVD, FORT MYERS, FL 33907-1101
(239) 278-4448
(239) 939-1286
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
PO0001857
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87996
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
10/15/2012
Last updated
05/13/2013
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