Individual
MARK WEISSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7815 NW 23RD ST, BETHANY, OK 73008
(405) 792-2147
(405) 603-1465
Mailing address
7815 NW 23RD ST, BETHANY, OK 73008-4947
(405) 792-2147
(405) 603-1465
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15521
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230000A
—
OK
01
—
374380YRHZ
MEDICARE PTAN
OK
Enumeration date
04/17/2007
Last updated
05/16/2023
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