Provider Demographics
NPI:1437118395
Name:WEISS, JAY A (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
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 1:300 WASHINGTON ST
Mailing Address - Street 2:STE 208
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6714
Mailing Address - Country:US
Mailing Address - Phone:318-322-8482
Mailing Address - Fax:318-322-5694
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:STE 208
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6714
Practice Address - Country:US
Practice Address - Phone:318-322-8482
Practice Address - Fax:318-322-5694
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12286R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1533980Medicaid
G60618Medicare UPIN
LA1533980Medicaid