Healthcare Provider Details

I. General information

NPI: 1588273601
Provider Name (Legal Business Name): BRETT ALLYN WEIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEDICAL PARK DR E
BIRMINGHAM AL
35235-3401
US

IV. Provider business mailing address

908 HIGHLAND RD
BIRMINGHAM AL
35209-3422
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3130
  • Fax:
Mailing address:
  • Phone: 205-541-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-115156
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: