Provider Demographics
NPI:1649266032
Name:WEISSIG, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:WEISSIG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:279 IMPERIAL HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1041
Mailing Address - Country:US
Mailing Address - Phone:714-449-4800
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:2141 N HARBOR BLVD
Practice Address - Street 2:SUITE 25000
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3827
Practice Address - Country:US
Practice Address - Phone:714-626-8610
Practice Address - Fax:714-626-8655
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-04-25
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Provider Licenses
StateLicense IDTaxonomies
CAG49175207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG49175FMedicare PIN
CAA51285Medicare UPIN