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Individual

DR. BRENT C. WESENBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5234 SW PHILOMATH BLVD, CORVALLIS, OR 97333-1042
(541) 768-4970
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
MD26812
OR
207P00000X
Emergency Medicine Physician
Primary
MD26812
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00389270
MEDICARE RAILROAD
OR
05
240516
OR
Enumeration date
05/27/2006
Last updated
11/10/2020
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