Provider Demographics
NPI:1154347995
Name:WEIS, TERRY J (DO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:WEIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16582 BAXTER FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4662
Mailing Address - Country:US
Mailing Address - Phone:314-291-7900
Mailing Address - Fax:
Practice Address - Street 1:12266 DEPAUL DR
Practice Address - Street 2:110
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2514
Practice Address - Country:US
Practice Address - Phone:314-291-7900
Practice Address - Fax:314-291-7914
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240975904Medicaid
MO240975904Medicaid
MO014010855Medicare ID - Type Unspecified