Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G41966 | CA |
NPI | 1043398126 |
---|---|
Provider Name | Gordon A. Weiss |
First Address | Oakland, CA 94612-3429 |
Second Address | Martinez, CA 94553-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G419660 | (05) | CA |
G07528 | (02) |