Provider Demographics
NPI:1679614408
Name:WEISS, GEORGE DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DEREK
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:2716 OLD ROSEBUD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8559
Practice Address - Country:US
Practice Address - Phone:859-543-1577
Practice Address - Fax:859-543-1637
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30697208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000282814OtherATHEM
KY0765501Medicare ID - Type Unspecified
KYE88110Medicare UPIN