Provider Demographics
NPI:1639670235
Name:LEE WEISS MD, PLLC
Entity Type:Organization
Organization Name:LEE WEISS MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-308-7817
Mailing Address - Street 1:PO BOX 27643
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0144
Mailing Address - Country:US
Mailing Address - Phone:602-318-6857
Mailing Address - Fax:
Practice Address - Street 1:20950 N TATUM BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4252
Practice Address - Country:US
Practice Address - Phone:480-820-9140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty