Healthcare Provider Details

I. General information

NPI: 1205088085
Provider Name (Legal Business Name): ERIK DANIEL WEISS M.D. M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST RADIOLOGY DEPARTMENT
JACKSON MS
39216-4500
US

IV. Provider business mailing address

4701 LAKELAND DR APT. 19D
FLOWOOD MS
39232-9506
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-1756
  • Fax:
Mailing address:
  • Phone: 718-869-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number258541-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number258541-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: