Provider Demographics
NPI:1881670263
Name:WEISMAN, RANDY S (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:S
Last Name:WEISMAN
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 1:3370 N. HAYDEN RD.
Mailing Address - Street 2:#123-407
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-947-1130
Mailing Address - Fax:480-947-1132
Practice Address - Street 1:3370 N. HAYDEN RD.
Practice Address - Street 2:#123-407
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-947-1130
Practice Address - Fax:480-947-1132
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65246207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ191243OtherAHCCCS - ARIZONA
FL272333600Medicaid
AZ191243OtherAHCCCS - ARIZONA
23783XMedicare ID - Type Unspecified