MEDICARE: MARK WEEMS P. E.

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	246ZI1000X	Medical Illustrator	PE.0040836	CO

General Provider Information

NPI Number	:	1952758856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WEEMS P. E.

Provider Business Mailing Address
First Line	:	50 LONG HOLLOW LN
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7120
Country	:	US
Telephone Number	:	970-749-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 LONG HOLLOW LN
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7120
Country	:	US
Telephone Number	:	970-749-0624
Fax Number	:

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

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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