Provider Demographics
NPI:1215026158
Name:WEISS, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
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 1:508 JEFFORDS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3839
Mailing Address - Country:US
Mailing Address - Phone:727-443-7700
Mailing Address - Fax:727-461-4379
Practice Address - Street 1:508 JEFFORDS ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3839
Practice Address - Country:US
Practice Address - Phone:727-443-7700
Practice Address - Fax:727-461-4379
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68174207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378580700Medicaid
FLG05918Medicare UPIN
FL26977Medicare ID - Type Unspecified