Provider Demographics
NPI:1053308965
Name:WEISS, EDUARDO T (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:T
Last Name:WEISS
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 1:3850 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6748
Mailing Address - Country:US
Mailing Address - Phone:954-961-1200
Mailing Address - Fax:954-963-0378
Practice Address - Street 1:3850 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6748
Practice Address - Country:US
Practice Address - Phone:954-961-1200
Practice Address - Fax:954-963-0378
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75865207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44849Medicare ID - Type Unspecified
FLG86283Medicare UPIN