Provider Demographics
NPI:1194736561
Name:BRYAN WECKEL MD FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:BRYAN WECKEL MD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MONTY
Authorized Official - Last Name:WECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-259-1718
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-1266
Mailing Address - Country:US
Mailing Address - Phone:910-259-1718
Mailing Address - Fax:910-259-9929
Practice Address - Street 1:310 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5048
Practice Address - Country:US
Practice Address - Phone:910-259-1718
Practice Address - Fax:910-259-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty