Organization
GARY L WEASE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY LANE WEASE MD (PRESIDENT/OWNER)
(810) 733-9760
Entity
Organization
Contact information
Practice address
G3286 BEECHER RD, SUITE E, FLINT, MI 48532-3614
(810) 733-9760
Mailing address
PO BOX 320309, FLINT, MI 48532-0006
(810) 733-9760
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202510241
BCBSM PROVIDER #
MI
01
—
0980253
HEALTHPLUS
MI
01
—
1007216
MCLAREN HEALTH PLAN
MI
05
—
103347535
—
MI
01
—
139110
GREAT LAKES HEALTH PLAN
MI
01
—
C5296
MCARE PROVIDER #
MI
01
—
P00096336
RAILROAD MEDICARE PROV #
MI
Enumeration date
01/29/2008
Last updated
07/31/2008
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