Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 201036 | LA |
NPI | 1255549101 |
---|---|
Provider Name | Dr. Sean Richard Weiss |
First Address | Metairie, LA 70002-6323 |
Second Address | Metairie, LA 70002-6323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1238333 | (05) | LA |