Healthcare Provider Details

I. General information

NPI: 1013985191
Provider Name (Legal Business Name): DANIEL E WESCHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W FOREST AVE SUITE 201
FLAGSTAFF AZ
86001-1479
US

IV. Provider business mailing address

PO BOX 10577
SCOTTSDALE AZ
85271-0577
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2222
  • Fax: 928-773-2598
Mailing address:
  • Phone: 928-773-2222
  • Fax: 928-773-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: