Individual
PETER L WEIDENFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3061 S MARYLAND PKWY, SUITE 102, LAS VEGAS, NV 89109-2298
(702) 731-2888
(702) 696-9289
Mailing address
1 INDEPENDENCE PT STE 202, GREENVILLE, SC 29615-4536
(877) 406-2916
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
8964
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200290223
—
NV
01
—
300099460
RR MEDICARE
—
01
—
NV8572
BLUE
NV
Enumeration date
01/09/2006
Last updated
01/11/2013
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