Provider Demographics
NPI:1952758856
Name:WEEMS, MARK (P E)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEEMS
Suffix:
Gender:M
Credentials:P E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LONG HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7120
Mailing Address - Country:US
Mailing Address - Phone:970-749-0624
Mailing Address - Fax:
Practice Address - Street 1:50 LONG HOLLOW LN
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7120
Practice Address - Country:US
Practice Address - Phone:970-749-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPE.0040836246ZI1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZI1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherIllustration, Medical