Healthcare Provider Details

I. General information

NPI: 1619921574
Provider Name (Legal Business Name): STUART WEISMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW STE 204
ALBUQUERQUE NM
87114-5917
US

IV. Provider business mailing address

515 SOUTH DR SUITE 12
MOUNTAIN VIEW CA
94040-4204
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7833
  • Fax: 505-727-9590
Mailing address:
  • Phone: 650-962-1100
  • Fax: 650-887-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01095561A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG57035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: