Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME75865 | FL |
NPI | 1053308965 |
---|---|
Provider Name | Eduardo T Weiss |
First Address | Hollywood, FL 33021-6748 |
Second Address | Hollywood, FL 33021-6748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86283 | (02) | FL |