Provider Demographics
NPI:1861411548
Name:WEISS, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:WEISS
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 1:222 S 1ST ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5404
Mailing Address - Country:US
Mailing Address - Phone:502-583-2731
Mailing Address - Fax:502-583-2733
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-587-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY182842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753840Medicaid
KY000000062489OtherANTHEM BLUE FACET
OH2126578Medicaid
KY1058377Medicaid
FL9097732-00Medicaid
TX060788901Medicaid
KY64182843Medicaid
IN100321650Medicaid
WV0198978000Medicaid
KY100321650OtherMANAGED HEALTH SERVICES
CAXPY200543Medicaid
KY00503003Medicare PIN
KY000000062489OtherANTHEM BLUE FACET
KY1279206Medicare ID - Type Unspecified
KY1058377Medicaid
IN100321650Medicaid
FL9097732-00Medicaid
OH2126578Medicaid
NY02753840Medicaid