Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD070098L | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD070098L | PA |
NPI | 1063428597 |
---|---|
Provider Name | Mitchell J Weiss |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105-3678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 20/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001757632 | (05) | PA |
8218609 | (05) | NJ |
F82729 | (02) |