Provider Demographics
NPI:1407930720
Name:WEISS, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2310 PASEO DEL PRADO
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4357
Mailing Address - Country:US
Mailing Address - Phone:702-385-5992
Mailing Address - Fax:702-385-5993
Practice Address - Street 1:2310 PASEO DEL PRADO
Practice Address - Street 2:SUITE A-110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4357
Practice Address - Country:US
Practice Address - Phone:702-385-5992
Practice Address - Fax:702-385-5993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3710207N00000X
CAG38380207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96691Medicare UPIN