Healthcare Provider Details

I. General information

NPI: 1508952045
Provider Name (Legal Business Name): HOWARD BRUCE WEISS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 UNIVERSITY BLVD S SUITE 103
JACKSONVILLE FL
32216-4312
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4252
US

V. Phone/Fax

Practice location:
  • Phone: 904-345-7373
  • Fax: 904-345-7372
Mailing address:
  • Phone: 904-345-7776
  • Fax: 904-345-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS0006203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: