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Organization
LAURENCE WEIDER MD PA
Active
Organization
LAURENCE WEIDER MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURENCE AVRAM WEIDER M.D. (PLASTIC SURGEON)
(972) 566-8444
Entity
Organization
Contact information
Practice address
7777 FOREST LN, SUITE B-145, DALLAS, TX 75230-2505
(972) 566-8444
(972) 566-8453
Mailing address
7777 FOREST LN, SUITE B-145, DALLAS, TX 75230-2505
(972) 566-8444
(972) 566-8453
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
J4602
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50EJ
BCBS ID NO
TX
Enumeration date
11/17/2006
Last updated
03/12/2008
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