Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME101775 | FL |
NPI | 1124075692 |
---|---|
Provider Name | Bryan Christian Steele Weidner |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/09/2015 |