Healthcare Provider Details

I. General information

NPI: 1225010747
Provider Name (Legal Business Name): JOSEPH M WEZENSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 BOOKCLIFF AVE
GRAND JUNCTION CO
81501-8107
US

IV. Provider business mailing address

735 BOOKCLIFF AVE
GRAND JUNCTION CO
81501-8107
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-4660
  • Fax: 970-248-9519
Mailing address:
  • Phone: 970-263-4660
  • Fax: 970-248-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number33169
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: