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General NPI Number Information
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NPI Number | 1154323392
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Entity Type | Individual
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Provider Name | DONALD L WEESE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1501 HILAND AVE STE H
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City | BURLEY
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State | ID
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Zip | 83318-2688
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Country | US
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Telephone | 208-677-6266
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30180
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0180
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 33863
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | M-6230
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License Number State | ID
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