Provider Demographics
NPI:1255392999
Name:WEISS, TERRY DAVID (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DAVID
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 1:522 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6857
Mailing Address - Country:US
Mailing Address - Phone:314-567-5100
Mailing Address - Fax:314-567-3387
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6857
Practice Address - Country:US
Practice Address - Phone:314-567-5100
Practice Address - Fax:314-567-3387
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34693207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12730OtherMERCY
MO3200024OtherUNITED HEALTH CARE
MO200860211Medicaid
MO118472OtherHEALTHLINK
MO5792081OtherAETNA
MO18210OtherBLUE CROSS BLUE SHIELD
MOA12740OtherGREAT WEST
MOA12740OtherPHCS
MO003010447Medicare ID - Type Unspecified
MOA12730OtherMERCY