Healthcare Provider Details

I. General information

NPI: 1093752867
Provider Name (Legal Business Name): FRANK TODD WEGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREENWAY CIRCLE
ERWIN TN
37650
US

IV. Provider business mailing address

PO BOX 1433
ERWIN TN
37650
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-1271
  • Fax:
Mailing address:
  • Phone: 423-743-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD0000037914
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: