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General NPI Number Information
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NPI Number | 1164609442
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Entity Type | Organization
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Legal Business Name | GARY L WEASE MD PC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | G3286 BEECHER RD SUITE E
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City | FLINT
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State | MI
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Zip | 48532-3614
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Country | US
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Telephone | 810-733-9760
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320309
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City | FLINT
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State | MI
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Zip | 48532-0006
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Country | US
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Telephone | 810-733-9760
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | GARY LANE WEASE
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Credential | MD
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Telephone | 810-733-9760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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