Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | Q5124 | TX |
NPI | 1093977472 |
---|---|
Provider Name | Dr. Justin D'annibale Weigand |
First Address | San Antonio, TX 78207 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 31/08/2015 |