Individual
DR. MARC W. WEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
(805) 773-2650
(805) 773-2655
Mailing address
2 JAMES WAY, SUITE 115, PISMO BEACH, CA 93449-4973
(805) 773-2650
(805) 773-2655
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A44223
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A442230
BLUE SHIELD
CA
05
—
00A442230
—
CA
01
—
611373100
USDL PIN
—
01
—
786185
CCN/FIRST HEALTH
—
01
—
7941133
AETNA
—
01
—
A44223
BLUE CROSS
CA
Enumeration date
03/01/2006
Last updated
06/10/2010
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