Healthcare Provider Details

I. General information

NPI: 1528036654
Provider Name (Legal Business Name): J. PETER WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD FL 4
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 E MCDOWELL RD FL 4
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3090
  • Fax: 602-521-3661
Mailing address:
  • Phone: 602-521-3090
  • Fax: 602-521-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5742146-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number5742146-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: