MEDICARE: DR. ROBERT WILLIAM WEGNER M.D.

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	46215	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103I026675	OTHER	TN	PROVIDER TRANSACTION ACCOUNT NUMBER (PTAN)

General Provider Information

NPI Number	:	1467680686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WILLIAM WEGNER M.D.

Provider Business Mailing Address
First Line	:	6005 PARK AVE STE 112
Second Line	:	SAINT FRANCIS CENTER FOR SURGICAL WEIGHT LOSS
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5240
Country	:	US
Telephone Number	:	901-765-3040
Fax Number	:	901-765-3049

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 112
Second Line	:	SAINT FRANCIS CENTER FOR SURGICAL WEIGHT LOSS
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5240
Country	:	US
Telephone Number	:	901-765-3040
Fax Number	:	901-765-3049

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	03/09/2011

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