Provider Demographics
NPI:1528036654
Name:WEISS, J. PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:PETER
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 1:755 E MCDOWELL RD FL 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2506
Mailing Address - Country:US
Mailing Address - Phone:602-521-3090
Mailing Address - Fax:602-521-3661
Practice Address - Street 1:755 E MCDOWELL RD FL 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2506
Practice Address - Country:US
Practice Address - Phone:602-521-3090
Practice Address - Fax:602-521-3661
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5742146-1205207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120816100Medicaid
ID807031600Medicaid
NV100504990Medicaid
UTD5862Medicaid
P00172961OtherRR MEDICARE
P00172961OtherRR MEDICARE
UTD5862Medicaid
WYW20215Medicare PIN
UT005517111Medicare PIN