| Entity Name: | GREGORY S. WEATHERFORD, M.D., INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Mar 1999 (26 years ago) |
| Document Number: | P99000022997 |
| FEI/EIN Number | 650902001 |
| Address: | 505 SE 6th Avenue, BOYNTON BEACH, FL, 33435, US |
| Mail Address: | 505 SE 6th Avenue, BOYNTON BEACH, FL, 33435, US |
| ZIP code: | 33435 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770677981 | 2006-10-03 | 2024-05-08 | 505 SE 6TH AVE, BOYNTON BEACH, FL, 334354921, US | 505 SE 6TH AVE, BOYNTON BEACH, FL, 334354921, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 561-734-8400 |
| Fax | 5617328807 |
Authorized person
| Name | GREGORY S WEATHERFORD |
| Role | PRESIDENT-DIRECTOR |
| Phone | 5617348400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | 080136104 |
| Name | Role | Address |
|---|---|---|
| WEATHERFORD GREGORY S | Agent | 2609 WOOLBRIGHT ROAD, #1, BOYNTON BEACH, FL, 33436 |
| Name | Role | Address |
|---|---|---|
| WEATHERFORD GREGORY S | President | 2609 WOOLBRIGHT ROAD, #1, BOYNTON BEACH, FL, 33436 |
| Name | Role | Address |
|---|---|---|
| WEATHERFORD GREGORY S | Director | 2609 WOOLBRIGHT ROAD, #1, BOYNTON BEACH, FL, 33436 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
