Provider Demographics
NPI:1487890471
Name:WEISS, LAURENCE ALLEN (M D)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ALLEN
Last Name:WEISS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:LAURENCE
Other - Middle Name:A
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3530 N 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2450
Mailing Address - Country:US
Mailing Address - Phone:954-261-5540
Mailing Address - Fax:
Practice Address - Street 1:3530 N 45TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2450
Practice Address - Country:US
Practice Address - Phone:954-261-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine