Provider Demographics
NPI:1588679260
Name:STEVEN J. WEISS M.D. INC
Entity Type:Organization
Organization Name:STEVEN J. WEISS M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:IX
Authorized Official - Credentials:MD
Authorized Official - Phone:562-861-0897
Mailing Address - Street 1:11411 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE #401
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5003
Mailing Address - Country:US
Mailing Address - Phone:562-861-0897
Mailing Address - Fax:562-862-2297
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-861-0897
Practice Address - Fax:562-862-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39288207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47771Medicare UPIN