MEDICARE: DR. HARLAN JAY WEISS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	T9529	TX
2	207R00000X	Internal Medicine Physician	MD.12466R	LA

General Provider Information

NPI Number	:	1932215456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARLAN JAY WEISS M.D.

Provider Business Mailing Address
First Line	:	5400 E TEXAS ST
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-6906
Country	:	US
Telephone Number	:	318-675-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 E TEXAS ST
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-6906
Country	:	US
Telephone Number	:	318-675-1313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	05/12/2023

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