Provider Demographics
NPI:1609975184
Name:WEISS, REBECCA ILENE (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ILENE
Last Name:WEISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:WEISS
Other - Last Name:GLASOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2060 W. WHISPERING WIND DRIVE
Mailing Address - Street 2:SUITE 173
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-565-5060
Mailing Address - Fax:623-565-5061
Practice Address - Street 1:2060 W. WHISPERING WIND DRIVE
Practice Address - Street 2:SUITE 173
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:623-565-5060
Practice Address - Fax:623-565-5061
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH73455Medicare UPIN