Healthcare Provider Details

I. General information

NPI: 1063627735
Provider Name (Legal Business Name): WEISS MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 BIG HORN RD SUITE 7DD
VAIL CO
81657-4783
US

IV. Provider business mailing address

PO BOX 4838
EAGLE CO
81631-4838
US

V. Phone/Fax

Practice location:
  • Phone: 970-477-0700
  • Fax:
Mailing address:
  • Phone: 970-477-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35800
License Number StateCO

VIII. Authorized Official

Name: DR. GARY M WEISS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 321-727-9063