Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 3125 | WV |
NPI | 1811257231 |
---|---|
Provider Name | Dr. Mark Anthony Weitzel |
First Address | Princeton, WV 24740-1369 |
Second Address | Princeton, WV 24740-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2012 |
Last Update Date | 25/09/2018 |