MEDICARE: GARY M WEISS 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	2084N0400X	Neurology Physician	ME39943	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62367	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710967328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY M WEISS MD

Provider Business Mailing Address
First Line	:	1051 PORT MALABAR BLVD NE
Second Line	:	SUITE 6
City	:	PALM BAY
State	:	FL
Zip	:	32905-5153
Country	:	US
Telephone Number	:	321-727-9063
Fax Number	:	321-728-1955

Provider Business Practice Location Address
First Line	:	1051 PORT MALABAR BLVD NE
Second Line	:	SUITE 6
City	:	PALM BAY
State	:	FL
Zip	:	32905-5153
Country	:	US
Telephone Number	:	321-727-9063
Fax Number	:	321-728-1955

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	01/25/2010

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