Provider Demographics
NPI:1043211337
Name:WEIDMAN, ELLIOTT RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:RUSSELL
Last Name:WEIDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FANNIN ST
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1920
Mailing Address - Country:US
Mailing Address - Phone:713-791-1874
Mailing Address - Fax:713-796-2343
Practice Address - Street 1:7400 FANNIN ST
Practice Address - Street 2:SUITE 850
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1920
Practice Address - Country:US
Practice Address - Phone:713-791-1874
Practice Address - Fax:713-796-2343
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5412207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27462Medicare UPIN
892894Medicare ID - Type Unspecified