Provider Demographics
NPI:1104938372
Name:WEISS, JORDEN BRENT (JORDEN WEISS DO)
Entity type:Individual
Prefix:DR
First Name:JORDEN
Middle Name:BRENT
Last Name:WEISS
Suffix:
Gender:M
Credentials:JORDEN WEISS DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 E. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-759-5075
Mailing Address - Fax:614-759-5079
Practice Address - Street 1:5965 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-759-5075
Practice Address - Fax:614-759-5079
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006906W2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WE4012193Medicare ID - Type Unspecified
OHF88656Medicare UPIN