Provider Demographics
NPI:1780878876
Name:WEISS, PHILIP S (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1734
Mailing Address - Country:US
Mailing Address - Phone:504-277-0087
Mailing Address - Fax:504-277-0086
Practice Address - Street 1:8050 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1734
Practice Address - Country:US
Practice Address - Phone:504-277-0087
Practice Address - Fax:504-277-0086
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD201537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1217000Medicaid