Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | OS0006203 | FL |
Y | 213ES0000X | Sports Medicine | OS0006203 | FL |
NPI | 1508952045 |
---|---|
Provider Name | Dr. Howard Bruce Weiss |
First Address | Jacksonville, FL 32216-4252 |
Second Address | Jacksonville, FL 32216-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 31/05/2012 |