Individual
JACK GILBERT WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
77 W FOREST AVE, SUITE 207, FLAGSTAFF, AZ 86001-1479
(928) 773-2505
(928) 773-2504
Mailing address
77 W FOREST AVE, SUITE 207, FLAGSTAFF, AZ 86001-1479
(928) 773-2505
(928) 773-2504
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0011
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363242
—
AZ
Enumeration date
08/10/2006
Last updated
02/05/2008
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