MEDICARE: PAULA E. WEGERT, MD, PROFESSIONAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1427289164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULA E. WEGERT, MD, PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	790 POLLUX DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1084
Country	:	US
Telephone Number	:	210-241-6810
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 POLLUX DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1084
Country	:	US
Telephone Number	:	210-241-6810
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	PAULA ELAINE WEGERT
Credential	:	MD
Telephone Number	:	210-241-6810

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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