Individual
LAWRENCE D WEIDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
860 BELTLINE RD, SPRINGFIELD, OR 97477-1091
(541) 344-4168
(458) 201-8510
Mailing address
12469 US HIGHWAY 98 W, MIRAMAR BEACH, FL 32550-8305
(850) 654-3376
(850) 654-3320
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA217838
OR
363AM0700X
Medical Physician Assistant
Primary
PA217838
OR
Other
Enumeration date
04/28/2006
Last updated
03/14/2026
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