Provider Demographics
NPI:1912260811
Name:WEI, ETHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:WEI
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 1:9085 E MINERAL CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3462
Mailing Address - Country:US
Mailing Address - Phone:303-801-0129
Mailing Address - Fax:303-586-8206
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-951-4059
Practice Address - Fax:303-951-4060
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN390200000X
CO55496208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program