Healthcare Provider Details

I. General information

NPI: 1346293958
Provider Name (Legal Business Name): ROBERT ALAN WEISMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-6197
  • Fax: 858-822-6198
Mailing address:
  • Phone: 858-822-6197
  • Fax: 858-822-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG28603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: