Provider Demographics
NPI:1134347057
Name:WEISS, JEFFREY ADAM (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ADAM
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13540 W CAMINO DEL SOL STE 15
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4472
Mailing Address - Country:US
Mailing Address - Phone:623-214-1602
Mailing Address - Fax:623-544-0701
Practice Address - Street 1:13540 W CAMINO DEL SOL STE 15
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4472
Practice Address - Country:US
Practice Address - Phone:623-214-1602
Practice Address - Fax:623-544-0701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ450213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU61829Medicare UPIN