Healthcare Provider Details

I. General information

NPI: 1942469408
Provider Name (Legal Business Name): JACQUELINE MARIE WEGGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N KOBAYASHI STE 209
WEBSTER TX
77598-4841
US

IV. Provider business mailing address

PO BOX 58538
WEBSTER TX
77598-8538
US

V. Phone/Fax

Practice location:
  • Phone: 281-962-7006
  • Fax: 832-932-5132
Mailing address:
  • Phone: 281-962-7006
  • Fax: 832-932-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberR2031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: