Provider Demographics
NPI:1225010747
Name:WEZENSKY, JOSEPH M (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:WEZENSKY
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 1:735 BOOKCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8107
Mailing Address - Country:US
Mailing Address - Phone:970-263-4660
Mailing Address - Fax:970-248-9519
Practice Address - Street 1:735 BOOKCLIFF AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8107
Practice Address - Country:US
Practice Address - Phone:970-263-4660
Practice Address - Fax:970-248-9519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33169173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF84372Medicare UPIN