Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | P9133 | TX |
NPI | 1053755454 |
---|---|
Provider Name | Mr. William Michael Weiss |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 27/12/2019 |