Healthcare Provider Details

I. General information

NPI: 1326026055
Provider Name (Legal Business Name): BRIEN D WESTON M.S., CCC/A
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAR, NOSE & THROAT/48MEDICAL GROUP/SGOSLA RAF LAKENHEATH
APO AE
09464
GB

IV. Provider business mailing address

PSC 41 BOX 1271
APO AE
09464
GB

V. Phone/Fax

Practice location:
  • Phone: 011441638528575
  • Fax:
Mailing address:
  • Phone: 011441638528575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001994A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: