Individual
MR. HENRY MARTIN WEYRAUCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MISSION BLVD, JACKSON, CA 95642
(209) 223-7500
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A22584
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A225840
—
CA
Enumeration date
05/01/2006
Last updated
10/18/2011
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