Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 91-137 | NM |
Y | 207Q00000X | Family Doctor | 91-137 | NM |
NPI | 1649344532 |
---|---|
Provider Name | Dr. Stephen Philip Weiss |
First Address | Santa Fe, NM 87507 |
Second Address | Santa Fe, NM 87507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 15/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F21695 | (02) | NM |