Provider Demographics
NPI:1184734410
Name:WEISS, BARRY D (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:D
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 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-4024
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ARIZONA MEDICAL
Practice Address - Street 2:1501 N CAMPBELL AVENUE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4914207Q00000X, 207QG0300X
AZ10602207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210310Medicaid
AKMD48591Medicaid
AZ380000449OtherRAILROAD MEDICARE
AKMD48591Medicaid
AZ210310Medicaid
AK152661Medicare PIN