Provider Demographics
NPI:1912097502
Name:WEIS, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:WEIS
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2772
Mailing Address - Country:US
Mailing Address - Phone:763-236-0808
Mailing Address - Fax:763-236-6065
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:763-236-0808
Practice Address - Fax:763-236-6065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN69429207RH0003X, 207RX0202X
UT173374-1205207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology