Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2007018522 | MO |
NPI | 1023217890 |
---|---|
Provider Name | Dr. Brian Wegman |
First Address | Columbia, MO 65202 |
Second Address | Columbia, MO 65202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 13/08/2007 |