Individual
DR. EDRA BLACKBURN WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2020 WADSWORTH BLVD, STE 16, LAKEWOOD, CO 80214-5730
(303) 233-8701
(303) 233-2850
Mailing address
2020 WADSWORTH BLVD, STE 16, LAKEWOOD, CO 80214-5730
(303) 233-8701
(303) 233-2850
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24410
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01244102
—
CO
Enumeration date
08/25/2005
Last updated
03/09/2012
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