Provider Demographics
NPI:1497977334
Name:WEISS, AVI (MD)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-877-0814
Mailing Address - Fax:702-887-3238
Practice Address - Street 1:3150N TENAYA WAY 165
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0462
Practice Address - Country:US
Practice Address - Phone:702-877-0814
Practice Address - Fax:702-877-3238
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-050007208800000X
NV13116208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497977334Medicaid
NVCC067ZMedicare PIN