Provider Demographics
NPI:1639829393
Name:WEISS, RAVEN (MD)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:
Other - Last Name:BROWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:901 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3315
Mailing Address - Country:US
Mailing Address - Phone:785-242-9889
Mailing Address - Fax:785-229-8447
Practice Address - Street 1:901 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3315
Practice Address - Country:US
Practice Address - Phone:785-242-9889
Practice Address - Fax:785-229-8447
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-51666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine