Provider Demographics
NPI:1184736548
Name:WEISENBERGER, JOHN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:WEISENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:912 N DOUTY ST
Mailing Address - Street 2:D
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3918
Mailing Address - Country:US
Mailing Address - Phone:559-582-2846
Mailing Address - Fax:559-582-1808
Practice Address - Street 1:912 N DOUTY ST
Practice Address - Street 2:D
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3918
Practice Address - Country:US
Practice Address - Phone:559-582-2846
Practice Address - Fax:559-582-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A258511Medicaid
CAA24603Medicare UPIN
CA00A258511Medicaid