Healthcare Provider Details

I. General information

NPI: 1598993065
Provider Name (Legal Business Name): MARCUS WEISER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W 8TH ST
ONAGA KS
66521-9574
US

IV. Provider business mailing address

213 E 5TH ST
ONAGA KS
66521-9430
US

V. Phone/Fax

Practice location:
  • Phone: 785-889-4241
  • Fax: 785-889-4749
Mailing address:
  • Phone: 785-889-4241
  • Fax: 785-889-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7189
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-34404
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: