Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME47117 | FL |
NPI | 1013019918 |
---|---|
Provider Name | Dr. Richard Carl Weiss |
First Address | Daytona Beach, FL 32114-2709 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 10/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041569300 | (05) | FL |
D86201 | (02) | FL |