# MARC W. WEISE, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174650279
- **Authorized official:** MARC W WEISE MD (PRESIDENT)
- **Authorized official phone:** (805) 773-2650

## Contact information

- **Practice address:** 2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
- **Practice address phone:** (805) 773-2650
- **Practice address fax:** (805) 773-2655
- **Mailing address:** 2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
- **Mailing address phone:** (805) 773-2650
- **Mailing address fax:** (805) 773-2655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 2852009 | CA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 5684480001 | CA | — |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 05/15/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 611373100 | USDEPT OF LABOR | — |