Healthcare Provider Details

I. General information

NPI: 1215469036
Provider Name (Legal Business Name): JARED BLAKE WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

6330 N ANDREWS AVE STE 299
FT LAUDERDALE FL
33309-2130
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5500
  • Fax:
Mailing address:
  • Phone: 954-839-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME160648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: