Healthcare Provider Details

I. General information

NPI: 1124516844
Provider Name (Legal Business Name): SEAN R. WEISS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 VETERANS MEMORIAL BLVD STE 408
METAIRIE LA
70002-6326
US

IV. Provider business mailing address

6765 MILNE BLVD
NEW ORLEANS LA
70124-2242
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-3223
  • Fax:
Mailing address:
  • Phone: 504-488-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD.201036
License Number StateLA

VIII. Authorized Official

Name: DR. SEAN WEISS
Title or Position: OWNER
Credential: MD, FACS
Phone: 504-814-3223