Healthcare Provider Details

I. General information

NPI: 1043352982
Provider Name (Legal Business Name): SCOTT ADAM WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/07/2023
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-6000
  • Fax:
Mailing address:
  • Phone: 352-336-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number221406
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberME141484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: