Provider Demographics
NPI:1194763151
Name:DONALD L WEESE, M.D., P.C.
Entity type:Organization
Organization Name:DONALD L WEESE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-735-0007
Mailing Address - Street 1:844 WASHINGTON ST N
Mailing Address - Street 2:NUMBER 400
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3874
Mailing Address - Country:US
Mailing Address - Phone:208-735-0007
Mailing Address - Fax:208-735-0008
Practice Address - Street 1:844 WASHINGTON ST N
Practice Address - Street 2:NUMBER 400
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3874
Practice Address - Country:US
Practice Address - Phone:208-735-0007
Practice Address - Fax:208-735-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDF7202OtherRR MEDICARE
ID002721500Medicaid
ID002721500Medicaid