GARY M. WEISS, M.D., P.A. (NPI# 1003922618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003922618 |
| Entity Type | Organization |
| Organization Name | GARY M. WEISS, M.D., P.A. |
| Other Organization Name | WEISS & NEWBERRY MEDICAL ASSOCIATES |
| Practice Address |
1051 Port Malabar Blvd Ne Suite 6 Palm Bay FL 32905-5153 |
| Practice Telephone | 3217279063 |
| Practice Fax Number | 3217281955 |
| Mailing Telephone | 3217279063 |
| Mailing Fax Number | 3217281955 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2011-09-20 |
| Authorized Official Name | DR. GARY M WEISS (PRESIDENT) |
| Authorized Official Telephone | 3217279063 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 9168017 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 2100062 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 174400000X | Specialist | ME 62341 | FL | Other Service Providers |
| Y | 174400000X | Specialist | ME 39943 | FL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 066754400 | 05 | |
| FL | BLUE CROSS BLUE SHIELD | 62367 | 01 |
| Other Name | Type Code |
|---|---|
| Weiss & Newberry Medical Associates | Doing Business As Name - Organization |
| Street Address |
1051 PORT MALABAR BLVD NE SUITE 6 |
| City | PALM BAY |
| State | FL |
| Zip Code | 32905-5153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578550935 | Maryann Martin | Nurse Practitioner | 1051 Port Malabar Blvd Ne, Suite 6, Port Malabar Professional Bldg, Palm Bay, FL 32905-5153 | 2005-09-30 |
| 1578970091 | Kristina Galligan | Dentist | 1051 Port Malabar Blvd Ne, Palm Bay, FL 32905-5153 | 2014-07-16 |
| 1164782553 | Perdue Chiropractic Center, LLC | Chiropractor | 1051 Port Malabar Blvd Ne, Suite 2, Palm Bay, FL 32905-5153 | 2012-05-21 |
| 1174899041 | Martin Jacobson, D.c., P.a. | Chiropractor | 1051 Port Malabar Blvd Ne, Suite 2, Palm Bay, FL 32905-5153 | 2012-03-26 |
| 1295032654 | Perdue Chiropractic Center, P.a. | Chiropractor | 1051 Port Malabar Blvd Ne, Suite 2, Palm Bay, FL 32905-5153 | 2011-02-22 |
| 1285799791 | Medical Associates of Brevard LLC | Clinic/Center | 1051 Port Malabar Blvd Ne, # 9, Palm Bay, FL 32905-5153 | 2006-12-26 |
| 1922169788 | Jack Rosenkrantz | Dentist | 1051 Port Malabar Blvd Ne, Palm Bay, FL 32905-5153 | 2006-12-13 |
| 1922169325 | David Hernandez | Dentist | 1051 Port Malabar Blvd Ne, Palm Bay, FL 32905-5153 | 2006-12-12 |
| 1346326899 | Mahesh M Soni | Pediatrics | 1051 Port Malabar Blvd Ne, Suite 9, Palm Bay, FL 32905-5153 | 2006-10-27 |
| 1366530727 | Christopher Michael Allen | Optometrist | 1051 Port Malabar Blvd Ne, Palm Bay, FL 32905-5153 | 2006-10-11 |
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|---|---|---|---|---|
| 1306460928 | Lavell Woodard Jr. | Counselor | 4206 Pinewood Dr Ne, Palm Bay, FL 32905 | 2020-05-29 |
| 1548735699 | Aaron J Milton | Counselor | 1420 Sportsman Lane Ne, Palm Bay, FL 32905 | 2018-10-04 |
| 1871070417 | The Brevard Health Alliance Inc | Clinic/Center | 1361 Florida Ave Ne Ste 2, Palm Bay, FL 32905 | 2018-07-26 |
| 1699266361 | Coastal Visioncare LLC | Optometrist | 2186 Harris Ave Ne Ste 1, Palm Bay, FL 32905 | 2018-05-29 |
| 1184173981 | Jean Elyse Gautreaux | Social Worker | 2475 Palm Bay Rd Ne, Suite 130 #4, Palm Bay, FL 32905 | 2016-09-22 |
| 1174901607 | Reginald Shannon Seecharan | Developmental Therapist | 700 James Cir Ne, Palm Bay, FL 32905 | 2015-05-17 |
| 1881091254 | Courtney Taft | Physical Therapy Assistant | 1155 Malabar Road, Suite 1, Palm Bay, FL 32905 | 2014-12-01 |
| 1548513310 | Juda Marie Decara | Counselor | 4690 Lipscomb St Se, Suite 6c, Palm Bay, FL 32905 | 2012-10-18 |
| 1326308313 | Mohammad Idrees Md, P.a. | Internal Medicine | 1454 Belaire Lane N.e., Palm Bay, FL 32905 | 2012-05-23 |
| 1265704548 | Atm Amin Dds LLC | Dentist | 4620 Lipscomb St Ne, Suite 2, Palm Bay, FL 32905 | 2012-02-02 |
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| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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| 1235310558 | James Wilfred Gaidry | Specialist | 900 Eastlake St Se, Palm Bay, FL 32909-4559 | 2007-11-15 |
| 1023229853 | Bruce Ranne Wills | Specialist | 6050 Babcock St Se Ste 5, Palm Bay, FL 32909-4203 | 2007-05-24 |
| 1942363395 | Space Coast Neurology and Pain Management Pa | Specialist | 4951 Babcock St Ne, Suite 1, Palm Bay, FL 32905-2821 | 2006-12-18 |
| 1467569889 | Michael Newberry | Specialist | 1051 Port Malabar Blvd Ne, Suite 6, Palm Bay, FL 32905-5153 | 2006-08-23 |
| 1447238787 | Frank G Lee | Specialist | 5070 Minton Rd Nw, Suite 5, Palm Bay, FL 32907-1157 | 2006-01-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.