Provider Demographics
NPI:1821183815
Name:WEIS, JEFFREY ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROSS
Last Name:WEIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4815 W ARROWHEAD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4004
Mailing Address - Country:US
Mailing Address - Phone:218-625-1917
Mailing Address - Fax:
Practice Address - Street 1:4815 W ARROWHEAD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-4004
Practice Address - Country:US
Practice Address - Phone:218-625-1917
Practice Address - Fax:218-625-7182
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN42784207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN246970700Medicaid
MN246970700Medicaid
MNH14940Medicare UPIN