Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME72959 | FL |
NPI | 1073511846 |
---|---|
Provider Name | Richard J Weiss |
First Address | Ft Myers, FL 33911-7006 |
Second Address | Fort Myers, FL 33912-4343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 13/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
253309000 | (05) | FL |
E76678 | (02) |