Healthcare Provider Details

I. General information

NPI: 1619963568
Provider Name (Legal Business Name): DAVID W WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/27/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 SEMINOLE RD
ATLANTIC BEACH FL
32233-5971
US

IV. Provider business mailing address

2367 SEMINOLE ROAD
ATLANTIC BEACH FL
32233
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-2011
  • Fax:
Mailing address:
  • Phone: 904-465-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: