Doctor Name: | CARL PRICE WEIDENBACH |
NPI Number: | 1255541454 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D1848 |
Business Practice Address: | 5008 Augusta Cir College Station, TX - 778458983 |
Business Phone Number: | 9796909686 |
Business Fax Number: | 9796909766 |
Mailing Address: | 5008 Augusta Cir, COLLEGE STATION |
State: | TX |
Postal Code: | 778458983 |
Phone Number: | 9796909686 |
Fax Number: | 9796909766 |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D1848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |