Individual
ETHAN DAVID WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7412 OAKLEY DR, COLUMBIA, MO 65203-9339
(573) 705-8438
Mailing address
7412 OAKLEY DR, COLUMBIA, MO 65203-9339
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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