Individual
DR. LAURENCE A WEIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
J4602
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030446101
—
TX
01
—
181391100
OWCP
TX
01
—
50EJ
BLUE CROSS BLUE SHIELD
TX
01
—
76467
AMERIGROUP
TX
Enumeration date
09/14/2005
Last updated
03/29/2011
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