Provider Demographics
NPI:1588620546
Name:WEISS, SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
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 1:1955 NE 201ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1665
Mailing Address - Country:US
Mailing Address - Phone:305-792-9445
Mailing Address - Fax:954-518-9701
Practice Address - Street 1:4100 HOLLYWOOD BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6778
Practice Address - Country:US
Practice Address - Phone:954-518-4100
Practice Address - Fax:954-518-9701
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28925Medicare ID - Type Unspecified
FLG10441Medicare UPIN