Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 54225 | AZ |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 54225 | AZ |
NPI | 1770802613 |
---|---|
Provider Name | Dr. Savannah Gelesko Weedman |
First Address | Phoenix, AZ 85006-2837 |
Second Address | Phoenix, AZ 85006-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 20/09/2017 |