Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1595 | NC |
NPI | 1659487973 |
---|---|
Provider Name | Dr. Glenn W. Weckel |
First Address | Wilmington, NC 28405 |
Second Address | Wilmington, NC 28405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08936 | BCBS (01) | |
7908936 | (05) | NC |
T64530 | (02) |