Provider Demographics
NPI:1255366498
Name:WEISS, ROBERT ALAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2201 CANTU CT
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6260
Mailing Address - Country:US
Mailing Address - Phone:941-552-8341
Mailing Address - Fax:941-487-8025
Practice Address - Street 1:2201 CANTU CT
Practice Address - Street 2:SUITE 117
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6260
Practice Address - Country:US
Practice Address - Phone:941-552-8341
Practice Address - Fax:941-487-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069492400Medicaid
58301OtherBCBS
783597OtherAETNA
FL069492400Medicaid