Provider Demographics
NPI:1700979283
Name:WEISS, JOSEPH BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
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 1:18422 CALLE LA SERRA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-0132
Mailing Address - Country:US
Mailing Address - Phone:858-756-9800
Mailing Address - Fax:858-756-9985
Practice Address - Street 1:18422 CALLE LA SERRA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92091-0132
Practice Address - Country:US
Practice Address - Phone:858-756-9800
Practice Address - Fax:858-756-9985
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37436207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology