Healthcare Provider Details

I. General information

NPI: 1780767137
Provider Name (Legal Business Name): CHRISTOPHER WIEGAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 E TANQUE VERDE RD
TUSCON AZ
85715
US

IV. Provider business mailing address

6408 E TANQUE VERDE RD
TUSCON AZ
85715
US

V. Phone/Fax

Practice location:
  • Phone: 520-885-5558
  • Fax: 520-885-5559
Mailing address:
  • Phone: 520-885-5558
  • Fax: 520-885-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number29187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: