MEDICARE: DR. NATHAN T. WEGNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2000153518	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P0002191	OTHER	MO	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27335011	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1225031909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN T. WEGNER MD

Provider Business Mailing Address
First Line	:	5718 NE SAPPHIRE PL
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1177
Country	:	US
Telephone Number	:	816-718-2372
Fax Number	:

Provider Business Practice Location Address
First Line	:	5718 NE SAPPHIRE PL
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1177
Country	:	US
Telephone Number	:	816-718-2372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/23/2022

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