Provider Demographics
NPI:1588715312
Name:WEISS, GREGG M (HIS)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:M
Last Name:WEISS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-2563
Mailing Address - Country:US
Mailing Address - Phone:727-868-9555
Mailing Address - Fax:727-862-3769
Practice Address - Street 1:10806 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2563
Practice Address - Country:US
Practice Address - Phone:727-868-9555
Practice Address - Fax:727-862-3769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1334237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist