Provider Demographics
NPI:1780900910
Name:WEIDNER MEDICAL CONSULTING PLLC
Entity type:Organization
Organization Name:WEIDNER MEDICAL CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-263-9657
Mailing Address - Street 1:PO BOX 4452
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-4452
Mailing Address - Country:US
Mailing Address - Phone:928-263-9657
Mailing Address - Fax:
Practice Address - Street 1:2720 E CALLE MARQUEZ
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0851
Practice Address - Country:US
Practice Address - Phone:928-263-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty