Doctor Name: | MARK S WEIS |
NPI Number: | 1962453530 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 28932 |
Business Practice Address: | 100 Trade St Ste C Lexington, KY - 405112610 |
Business Phone Number: | 8592311176 |
Business Fax Number: | 8592311186 |
Mailing Address: | 151 N Eagle Creek Dr, Ste 100 LEXINGTON |
State: | KY |
Postal Code: | 405091889 |
Phone Number: | 8592634341 |
Fax Number: | 8592637441 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 28932 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |