Provider Demographics
NPI:1780650010
Name:WEIS, DENNIS A (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:WEIS
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 1:700 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2302
Mailing Address - Country:US
Mailing Address - Phone:515-263-2424
Mailing Address - Fax:515-263-2463
Practice Address - Street 1:700 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2302
Practice Address - Country:US
Practice Address - Phone:515-263-2424
Practice Address - Fax:515-263-2463
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21170207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08013182OtherRR MEDICARE
IA1780650010Medicaid
IA49413Medicare ID - Type Unspecified
IA1780650010Medicaid