Provider Demographics
NPI:1871680561
Name:WEIGEL, SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:F
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:PO BOX 35908
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0908
Mailing Address - Country:US
Mailing Address - Phone:214-525-0681
Mailing Address - Fax:214-525-0682
Practice Address - Street 1:7929 BROOKRIVER DR.
Practice Address - Street 2:# 180
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-525-0681
Practice Address - Fax:214-525-0682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8413208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113381103Medicaid
TX00255JMedicare PIN
TXG49399Medicare UPIN