Provider Demographics
NPI:1851431159
Name:WEISS, DAVID IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:WEISS
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 1:15 ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-582-7655
Mailing Address - Fax:601-582-3229
Practice Address - Street 1:15 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-582-7655
Practice Address - Fax:601-582-3229
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15589207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118558Medicaid
MS660003195OtherRR-MCARE
F95059Medicare UPIN
MS660003195OtherRR-MCARE