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Individual

GERALD WEDEMEYER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
327 MEDICAL PARK DRIVE, BRIDGEPORT, WV 26330
(681) 342-1525
(681) 342-3125
Mailing address
327 MEDICAL PARK DRIVE, BRIDGEPORT, WV 26330
(681) 342-1525
(681) 342-3125

Taxonomy

Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
WV16760
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10232000
MEDICAID
WV
Enumeration date
05/04/2006
Last updated
05/12/2014
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