Individual
EDWARD LYLE WEGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 9TH AVE NW, WATERTOWN, SD 57201-1548
(605) 882-7749
Mailing address
PO BOX 875, WATERTOWN, SD 57201-0875
(605) 882-5753
(605) 882-5759
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1305
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6600332
—
SD
Enumeration date
05/03/2006
Last updated
07/16/2007
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