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Organization
DERBY DERM
Active
Organization
DERBY DERM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM WEIDE P.A. (PRESIDENT)
(316) 788-3376
Entity
Organization
Contact information
Practice address
1121 N COLLEGE PARK ST, SUITE # 400, DERBY, KS 67037-3665
(316) 788-3376
(316) 788-3378
Mailing address
1121 N COLLEGE PARK ST, SUITE # 400, DERBY, KS 67037-3665
(316) 788-3376
(316) 788-3378
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500761
KS
Other
Enumeration date
01/31/2008
Last updated
01/31/2008
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