Provider Demographics
NPI:1164548855
Name:ZAK H WEIS DPM MS PA
Entity Type:Organization
Organization Name:ZAK H WEIS DPM MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ZAK
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-322-3338
Mailing Address - Street 1:1901 MEDI PARK DR STE 1054
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2108
Mailing Address - Country:US
Mailing Address - Phone:806-322-3338
Mailing Address - Fax:806-322-7653
Practice Address - Street 1:1901 MEDI PARK DR STE 1054
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2108
Practice Address - Country:US
Practice Address - Phone:806-322-3338
Practice Address - Fax:806-322-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1658213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5967070001Medicare NSC
TXU99049Medicare UPIN