Provider Demographics
NPI:1174651830
Name:WEPPNER, WILLIAM GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GUY
Last Name:WEPPNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2528
Mailing Address - Country:US
Mailing Address - Phone:208-870-3072
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:MSO 111
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1325
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044043207R00000X
MT11190207R00000X
IDM8854207R00000X
IDM-10887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4370WEOtherBLUE SHIELD VM