1245432715 NPI number — CHRISTOPHER M WEISS MD PA

Table of content: (NPI 1245432715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245432715 NPI number — CHRISTOPHER M WEISS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER M WEISS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245432715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1703 THONOTOSASSA RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33563-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-759-0757
Provider Business Mailing Address Fax Number:
813-759-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 THONOTOSASSA RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-759-0757
Provider Business Practice Location Address Fax Number:
813-759-0737
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-759-0757

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME47440 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 73255 . This is a "BLUE CROSS BLUE SHIELD NU" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME47440 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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