Individual
KENNETH S WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6286 BRIARCREST AVE STE 200, MEMPHIS, TN 38120-4023
(901) 641-3000
(901) 701-2400
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 641-3000
(901) 701-2400
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
34880
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
34880
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000125415
—
MS
05
—
110318002
—
AR
05
—
158715001
—
AR
01
—
200041126
RAILROAD MEDICARE
TN
05
—
3371161
—
TN
05
—
3863989
—
TN
01
—
3881110
CIGNA
TN
01
—
40106
TLC
UT
01
—
4014940
BCBS
TN
01
—
620819926
BCBS
MS
01
—
620819926
AETNA
TN
01
—
7146128
AETNA
TN
05
—
7187860
—
MS
Enumeration date
05/23/2005
Last updated
03/16/2021
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