Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 21170 | IA |
NPI | 1780650010 |
---|---|
Provider Name | Dennis A Weis |
First Address | Des Moines, IA 50316-2302 |
Second Address | Des Moines, IA 50316-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 15/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08013182 | RR MEDICARE (01) | IA |
1780650010 | (05) | IA |
A01787 | (02) | IA |