Provider Demographics
NPI:1346372620
Name:WEISS, WILLIAM RONALD (PAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RONALD
Last Name:WEISS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10001
Mailing Address - Street 2:PMB #814
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-285-3699
Mailing Address - Fax:
Practice Address - Street 1:9525 KING ST.
Practice Address - Street 2:FAIRWEATHER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-267-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK993363A00000X
MP0058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant