=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588150742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PABLO R WEILG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2018
-----------------------------------------------------
Last Update Date | 08/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BOSTON MEDICAL CTR PL
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02118-2908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-638-7460
-----------------------------------------------------
Fax | 617-638-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 S ILLINOIS AVE STE 103
-----------------------------------------------------
City | MASON CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50401-5489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-428-3041
-----------------------------------------------------
Fax | 641-428-3059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 287372
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------