Provider Demographics
NPI:1437142338
Name:WEISS, EDWARD S (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11125 DUNN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043458207RC0000X
MOR4677207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000011832OtherESSENCE
42988V30946OtherHLTHPART
10025V8816OtherHCUSA
2248981OtherCIGNA
A12743OtherMERCY
21785OtherMOBS/BLCHOICE
431098908OtherTRICARE
119140OtherHLNK
2500095OtherUHC
4001174OtherAETNA
IL060067878OtherILRRMCR
5914V3831OtherGHP/CMR
MO060031058OtherMORRMCR
MO200347508Medicaid
10025V8816OtherHCUSA
2248981OtherCIGNA
MO003010452Medicare PIN
4001174OtherAETNA
MO208050163Medicare PIN