Individual
DR. ALLEN C. WEGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
910 E HOUSTON ST, STE 600, TYLER, TX 75702-8369
(903) 526-2644
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
J2410
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1178196-01
—
TX
01
—
340018326
RR/MEDICARE
TX
01
—
75-2616977-007
TRICARE-DOUGLAS
TX
01
—
75-2616977-126
TRICARE
TX
01
—
82736F
BLUE SHIELD
TX
Enumeration date
04/03/2006
Last updated
02/17/2016
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