Healthcare Provider Details

I. General information

NPI: 1679614408
Provider Name (Legal Business Name): GEORGE DEREK WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 OLD ROSEBUD RD SUITE 350
LEXINGTON KY
40509-8559
US

IV. Provider business mailing address

230 LEXINGTON GREEN CIR STE 600
LEXINGTON KY
40503-3326
US

V. Phone/Fax

Practice location:
  • Phone: 859-543-1577
  • Fax: 859-543-1637
Mailing address:
  • Phone: 859-971-4695
  • Fax: 859-971-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30697
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: