Provider Demographics
NPI:1881692655
Name:WEISS, SAM JAY (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:JAY
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-346-2070
Mailing Address - Fax:760-346-4495
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-346-2070
Practice Address - Fax:760-346-4495
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG54907207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330198954OtherTAX ID #
CAA52824Medicare UPIN
CA330198954OtherTAX ID #