=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093932279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMMA WEISS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 09/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 FOREST LN SUITE C550
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-566-4286
-----------------------------------------------------
Fax | 972-566-8634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 961205
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76161-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-740-8450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L2742
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------