Organization
GORDON R. WEIGLE, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON REESE WEIGLE II M.D. (OWNER)
(803) 533-0091
Entity
Organization
Contact information
Practice address
1717 VILLAGE PARK DR, ORANGEBURG, SC 29118-2475
(803) 533-0091
(803) 533-6084
Mailing address
1717 VILLAGE PARK DR, ORANGEBURG, SC 29118-2475
(803) 533-0091
(803) 533-6084
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
SC8901
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3708
—
SC
Enumeration date
04/01/2008
Last updated
04/02/2008
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