Provider Demographics
NPI:1831164581
Name:WEISSMAN, WAYNE D (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:WEISSMAN
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 1:1221 MADISON
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1370
Mailing Address - Country:US
Mailing Address - Phone:206-292-6488
Mailing Address - Fax:206-623-2436
Practice Address - Street 1:1221 MADISON
Practice Address - Street 2:SUITE 1210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1370
Practice Address - Country:US
Practice Address - Phone:206-292-6488
Practice Address - Fax:206-623-2436
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018288208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00134471OtherMEDICARE RAILROAD
GAB06694Medicare ID - Type Unspecified
WAP00134471OtherMEDICARE RAILROAD