MEDICARE: DR. ELLIOTT RUSSELL WEIDMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	F5412	TX

General Provider Information

NPI Number	:	1043211337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOTT RUSSELL WEIDMAN MD

Provider Business Mailing Address
First Line	:	7400 FANNIN ST
Second Line	:	SUITE 850
City	:	HOUSTON
State	:	TX
Zip	:	77054-1920
Country	:	US
Telephone Number	:	713-791-1874
Fax Number	:	713-796-2343

Provider Business Practice Location Address
First Line	:	7400 FANNIN ST
Second Line	:	SUITE 850
City	:	HOUSTON
State	:	TX
Zip	:	77054-1920
Country	:	US
Telephone Number	:	713-791-1874
Fax Number	:	713-796-2343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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