Provider Demographics
NPI:1063627735
Name:WEISS MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:WEISS MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-727-9063
Mailing Address - Street 1:PO BOX 4838
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-4838
Mailing Address - Country:US
Mailing Address - Phone:970-477-0700
Mailing Address - Fax:
Practice Address - Street 1:3971 BIG HORN RD
Practice Address - Street 2:SUITE 7DD
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4783
Practice Address - Country:US
Practice Address - Phone:970-477-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35800OtherSTATE LIC NUMBER