Provider Demographics
NPI:1285847707
Name:WEISS, SHEPPHERD A (NMD)
Entity Type:Individual
Prefix:DR
First Name:SHEPPHERD
Middle Name:A
Last Name:WEISS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6134
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377
Mailing Address - Country:US
Mailing Address - Phone:480-775-0575
Mailing Address - Fax:480-900-8499
Practice Address - Street 1:36600 N. PIMA RD
Practice Address - Street 2:#209
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-775-0575
Practice Address - Fax:480-900-8499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ97502207RC0000X
AZ97-502175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MW2693528OtherDEA