Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 9157 | SD |
NPI | 1164615738 |
---|---|
Provider Name | Dr. Dustin James Weiss |
First Address | Sioux Falls, SD 57108-8148 |
Second Address | Sioux Falls, SD 57108-8148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 30/06/2014 |