Healthcare Provider Details

I. General information

NPI: 1508006933
Provider Name (Legal Business Name): ROBERT CHARLES WEISSMANN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17438 HARD HAT DR
COVINGTON LA
70435-5630
US

IV. Provider business mailing address

36 RIVERDALE DR
COVINGTON LA
70433-4524
US

V. Phone/Fax

Practice location:
  • Phone: 985-249-5600
  • Fax: 985-249-5618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.014606
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: