Organization
MARC W. WEISE, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC W WEISE MD (PRESIDENT)
(805) 773-2650
Entity
Organization
Contact information
Practice address
2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
(805) 773-2650
(805) 773-2655
Mailing address
2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
(805) 773-2650
(805) 773-2655
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2852009
CA
332B00000X
Durable Medical Equipment & Medical Supplies
5684480001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611373100
USDEPT OF LABOR
—
Enumeration date
02/27/2007
Last updated
05/15/2012
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