Provider Demographics
NPI:1538343215
Name:MERRIWEATHER, MARCUS JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:JEROME
Last Name:MERRIWEATHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5102
Mailing Address - Country:US
Mailing Address - Phone:407-831-4040
Mailing Address - Fax:407-260-0281
Practice Address - Street 1:661 E ALTAMONTE DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5102
Practice Address - Country:US
Practice Address - Phone:407-831-4040
Practice Address - Fax:407-260-0281
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100398207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBK511ZMedicare PIN