Provider Demographics
NPI:1013019918
Name:WEISS, RICHARD CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARL
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:HALIFAX REGIONAL ONCOLOGY CENTER
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-254-4212
Mailing Address - Fax:386-254-4214
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:HALIFAX REGIONAL ONCOLOGY CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-254-4212
Practice Address - Fax:386-254-4214
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME47117207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041569300Medicaid
FL041569300Medicaid
FLD86201Medicare UPIN