Provider Demographics
NPI:1215913009
Name:VON WEISS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VON WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 VILLAGE TRL E
Mailing Address - Street 2:UNIT #6
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5819
Mailing Address - Country:US
Mailing Address - Phone:612-465-9270
Mailing Address - Fax:
Practice Address - Street 1:1675 VILLAGE TRL E
Practice Address - Street 2:UNIT #6
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5819
Practice Address - Country:US
Practice Address - Phone:612-465-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine