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Individual

KENNETH WEISS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
10377 S US HIGHWAY 1, STE 101, PORT ST LUCIE, FL 34952-5630
(772) 337-3700
Mailing address
10377 S US HIGHWAY 1, STE 101, PORT ST LUCIE, FL 34952-5630
(772) 337-3700

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
036053048
IL
207Y00000X
Otolaryngology Physician
Primary
ME103347
FL

Other

Enumeration date
02/07/2007
Last updated
11/21/2012
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