Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD027994L | PA |
Y | 207PE0004X | Emergency Medical Services | MD027994L | PA |
NPI | 1003081167 |
---|---|
Provider Name | Jesse A Weigel |
First Address | Mechanicsburg, PA 17050-2298 |
Second Address | Mechanicsburg, PA 17050-2298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD027994L | STATE LICENSE (01) | PA |