Healthcare Provider Details

I. General information

NPI: 1417912452
Provider Name (Legal Business Name): JEFFREY N WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 COLONIAL DR #300
MARGATE FL
33063-5682
US

IV. Provider business mailing address

5800 COLONIAL DR STE 300
MARGATE FL
33063-5674
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-0044
  • Fax: 954-975-0338
Mailing address:
  • Phone: 954-975-0044
  • Fax: 954-975-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME49219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: