Healthcare Provider Details

I. General information

NPI: 1255549101
Provider Name (Legal Business Name): SEAN RICHARD WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 VETERANS MEMORIAL BLVD SUITE 408
METAIRIE LA
70002-6323
US

IV. Provider business mailing address

2201 VETERANS MEMORIAL BLVD SUITE 408
METAIRIE LA
70002-6323
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-3223
  • Fax: 504-265-9498
Mailing address:
  • Phone: 504-814-3223
  • Fax: 504-265-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number201036
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD201036
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: