Individual
MARK RICHARD WEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
60 W GORE STREET, ORLANDO, FL 32806-1101
(407) 351-5384
(407) 445-0321
Mailing address
60 W GORE STREET, ORLANDO, FL 32806-1101
(407) 351-5384
(407) 445-0321
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
ME62498
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1419354
—
LA
05
—
370776800
—
FL
05
—
7616163
—
NC
01
—
ME62498
MEDICAL LICENSE
FL
Enumeration date
08/29/2006
Last updated
11/10/2016
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