Provider Demographics
NPI:1013909241
Name:WEGG, DANIEL LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LLOYD
Last Name:WEGG
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-857-2523
Mailing Address - Fax:765-857-2304
Practice Address - Street 1:386 SYMMES CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9402
Practice Address - Country:US
Practice Address - Phone:765-857-2523
Practice Address - Fax:765-857-2304
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043837A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029692Medicaid
IN200045790Medicaid
IN000000836404OtherANTHEM
OH2029692Medicaid
IN000000359140OtherBC/BS # MASTERBRAND LOCAT
IN200045790Medicaid
IN168800BOtherMEDICARE PTAN
IN168830BOtherMEDICARE PTAN
OH2029692Medicaid
IN000000093883OtherBC/BS # RIDGEVILLE LOCATI
G13379Medicare UPIN