Provider Demographics
NPI:1063414928
Name:WEISS, THOMAS R (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8122 DATAPOINT DR
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3272
Mailing Address - Country:US
Mailing Address - Phone:210-614-5561
Mailing Address - Fax:210-614-8351
Practice Address - Street 1:8122 DATAPOINT DR
Practice Address - Street 2:SUITE 1010
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3272
Practice Address - Country:US
Practice Address - Phone:210-614-5561
Practice Address - Fax:210-614-8351
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG02732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00H72BMedicare ID - Type Unspecified
E76070Medicare UPIN