Provider Demographics
NPI:1215949771
Name:WEISS, JUDY (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:FUJITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:
Practice Address - Street 1:5130 W 80TH AVE
Practice Address - Street 2:SUITE A102
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4450
Practice Address - Country:US
Practice Address - Phone:303-427-5979
Practice Address - Fax:303-427-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24558207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COWE94851OtherBLUE SHIELD
CO01245588Medicaid
CO94851Medicare ID - Type Unspecified
COWE94851OtherBLUE SHIELD