Healthcare Provider Details

I. General information

NPI: 1528470457
Provider Name (Legal Business Name): LOREN S WESSEL DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 S 16TH AVE
TUCSON AZ
85713-6080
US

IV. Provider business mailing address

3722 S 16TH AVE
TUCSON AZ
85713-6080
US

V. Phone/Fax

Practice location:
  • Phone: 520-882-7009
  • Fax: 520-882-5227
Mailing address:
  • Phone: 520-882-7009
  • Fax: 520-882-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM0367
License Number StateAZ

VIII. Authorized Official

Name: DR. LOREN S WESSEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 520-882-7009