Provider Demographics
NPI:1720235021
Name:WILLIAM TODD WEISS M D
Entity type:Organization
Organization Name:WILLIAM TODD WEISS M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-766-1967
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-766-1967
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-766-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE96736Medicare UPIN
TN30631342Medicare PIN