MEDICARE: DR. ROBERT MICHAEL WEISS M.D.

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	207N00000X	Dermatology Physician	3710	NV
2	207N00000X	Dermatology Physician	G38380	CA

General Provider Information

NPI Number	:	1407930720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL WEISS M.D.

Provider Business Mailing Address
First Line	:	2310 PASEO DEL PRADO
Second Line	:	SUITE A-110
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4357
Country	:	US
Telephone Number	:	702-385-5992
Fax Number	:	702-385-5993

Provider Business Practice Location Address
First Line	:	2310 PASEO DEL PRADO
Second Line	:	SUITE A-110
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4357
Country	:	US
Telephone Number	:	702-385-5992
Fax Number	:	702-385-5993

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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