Individual
GREGORY JOHN WEISBRUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3500 GASTON AVENUE, DALLAS, TX 75246
(214) 826-8822
(214) 826-9792
Mailing address
3206 4TH ST, LONGVIEW, TX 75605-5143
(903) 663-4800
(903) 663-7394
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G8496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139986726
—
TX
05
—
139986727
—
TX
05
—
139986729
—
TX
Enumeration date
05/19/2006
Last updated
10/03/2017
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