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General NPI Number Information
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NPI Number | 1679755805
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Entity Type | Organization
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Legal Business Name | STEPHEN P WEISS
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 4137 MONTGOMERY BLVD NE (GRANADA SQUARE)
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-6741
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Country | US
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Telephone | 505-872-2611
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Fax | 505-872-8304
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Provider Business Mailing Address
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Address Line | 4137 MONTGOMERY BLVD NE (GRANADA SQUARE)
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-6741
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Country | US
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Telephone | 505-872-2611
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. STEPHEN P WEISS
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Credential | M.D
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Telephone | 505-872-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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