Healthcare Provider Details

I. General information

NPI: 1902854383
Provider Name (Legal Business Name): JEFFREY I WEISEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E WHITEHOUSE CANYON RD STE. 110 ARIZONA COMMUNITY PHYSICIANS PC
GREEN VALLEY AZ
85614-0538
US

IV. Provider business mailing address

5055 E BROADWAY BLVD SUITE A-100 ARIZONA COMMUNITY PHYSICIANS PC
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-3230
  • Fax: 520-625-9162
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: