Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME133618 | FL |
NPI | 1013370444 |
---|---|
Provider Name | Dr. Eric Michael Weiss |
First Address | Eglin Afb, FL 32542-1302 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2016 |
Last Update Date | 02/05/2018 |