Provider Demographics
NPI:1992733810
Name:WEISSMAN, ALLAN (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2590
Mailing Address - Country:US
Mailing Address - Phone:360-876-9158
Mailing Address - Fax:360-876-9220
Practice Address - Street 1:1950 POTTERY AVE STE 20
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2590
Practice Address - Country:US
Practice Address - Phone:360-876-9158
Practice Address - Fax:360-876-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1038579Medicaid
WAG000200544Medicare PIN
WA1038579Medicaid