Healthcare Provider Details

I. General information

NPI: 1255450649
Provider Name (Legal Business Name): GLENN HOWARD WEYHRICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 2ND ST STE 206
BOISE ID
83702-6130
US

IV. Provider business mailing address

222 N 2ND ST STE 206
BOISE ID
83702-6130
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-2516
  • Fax: 208-342-1661
Mailing address:
  • Phone: 208-342-2516
  • Fax: 208-342-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberM3119
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: