Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | GA33483 | GA |
NPI | 1528018082 |
---|---|
Provider Name | Edward Bruce Weiser |
First Address | Atlanta, GA 30309-1267 |
Second Address | Atlanta, GA 30309-1267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E16889 | (02) | GA |