MEDICARE: STEPHEN P WEISS

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679755805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN P WEISS

Provider Business Mailing Address
First Line	:	4137 MONTGOMERY BLVD NE
Second Line	:	(GRANADA SQUARE)
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6741
Country	:	US
Telephone Number	:	505-872-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4137 MONTGOMERY BLVD NE
Second Line	:	(GRANADA SQUARE)
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6741
Country	:	US
Telephone Number	:	505-872-2611
Fax Number	:	505-872-8304

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. STEPHEN P WEISS
Credential	:	M.D
Telephone Number	:	505-872-2611

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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Directions to “STEPHEN P WEISS ” Practice Location

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