Provider Demographics
NPI:1063429215
Name:WEISS, HOWARD IVAN (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:IVAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-569-3381
Mailing Address - Fax:314-569-1383
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:SUITE 324
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-569-3381
Practice Address - Fax:314-569-1383
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR51052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
168031OtherHEALTHLINK HMO/PPO
43102995602OtherCARE MGMT RESOURCES
130005594OtherRAILROAD MEDICARE
2145V43102995602OtherGROUP HEALTH PLAN
MO17836OtherANTHEM BLUE CROSS
MO05-00073OtherUHC MIDWEST
168031OtherHEALTHLINK HMO/PPO
MOA12720Medicare UPIN