1841274529 NPI number — DR. PETER N WEISSMAN MD

Table of content: DR. PETER N WEISSMAN MD (NPI 1841274529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841274529 NPI number — DR. PETER N WEISSMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISSMAN
Provider First Name:
PETER
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841274529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7867 N KENDALL DR
Provider Second Line Business Mailing Address:
SUITE 80
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-7735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-595-0777
Provider Business Mailing Address Fax Number:
305-412-9255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7867 N KENDALL DR
Provider Second Line Business Practice Location Address:
SUITE 80
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-7735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-595-0777
Provider Business Practice Location Address Fax Number:
305-412-9255
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME18664 , 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: 114353900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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