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Individual

GLENN HOWARD WEYHRICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
222 N 2ND ST STE 206, BOISE, ID 83702-6130
(208) 342-2516
(208) 342-1661
Mailing address
222 N 2ND ST STE 206, BOISE, ID 83702-6130
(208) 342-2516
(208) 342-1661

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
M3119
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010000709
REGENCE BLUE SHIELD OF ID
ID
05
002523800
ID
01
01602650631
AMA MEMBERSHIP
ID
01
13D0521509
CLIA LAB ID NUMBER
ID
01
140277
OMAP OREGON MEDICAID
OR
01
50120
BLUE CROSS OF IDAHO
ID
01
M3119
IDAHO STATE LICENSE
ID
01
MD1637
IDAHO CONTROLLED SUBSTANC
ID
Enumeration date
03/28/2007
Last updated
03/07/2023
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