Provider Demographics
NPI:1467680686
Name:WEGNER, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:WEGNER
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 1:6005 PARK AVE STE 112
Mailing Address - Street 2:SAINT FRANCIS CENTER FOR SURGICAL WEIGHT LOSS
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5240
Mailing Address - Country:US
Mailing Address - Phone:901-765-3040
Mailing Address - Fax:901-765-3049
Practice Address - Street 1:6005 PARK AVE STE 112
Practice Address - Street 2:SAINT FRANCIS CENTER FOR SURGICAL WEIGHT LOSS
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5240
Practice Address - Country:US
Practice Address - Phone:901-765-3040
Practice Address - Fax:901-765-3049
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I026675OtherPROVIDER TRANSACTION ACCOUNT NUMBER (PTAN)