Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 01043837A | IN |
NPI | 1013909241 |
---|---|
Provider Name | Dr. Daniel Lloyd Wegg |
First Address | Richmond, IN 47374-1157 |
Second Address | Ridgeville, IN 47380-1325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000836404 | ANTHEM (01) | IN |
200045790 | (05) | IN |
2029692 | (05) | OH |