MEDICARE: PHILLIP T WEIDNER DO

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	207L00000X	Anesthesiology Physician	DO158703	OR
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	DO158703	OR

General Provider Information

NPI Number	:	1891950853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP T WEIDNER DO

Provider Business Mailing Address
First Line	:	4921 SPORTSMAN DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4193
Country	:	US
Telephone Number	:	303-868-8247
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 SPORTSMAN DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4193
Country	:	US
Telephone Number	:	303-868-8247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	03/05/2026

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Directions to “ PHILLIP T WEIDNER DO” Practice Location

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