Provider Demographics
NPI:1255396263
Name:WEISS, MARTIN S (DO)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 W. UNIVERSITY DR
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:469-800-5350
Mailing Address - Fax:
Practice Address - Street 1:5236 W. UNIVERSITY DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:469-800-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3525207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060043559OtherRAILROAD MEDICARE PIN
TX0429367-05Medicaid
TX842608OtherBCBS
TX842608OtherBCBS
TXTXB154520Medicare PIN