Individual
MR. TIMOTHY L. WEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1121 N COLLEGE PARK ST, SUITE # 400, DERBY, KS 67037-3665
(316) 788-3376
(316) 788-3378
Mailing address
22120 SW WILLIAMS RD, DOUGLASS, KS 67039-8539
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500761
KS
Other
Enumeration date
05/20/2007
Last updated
02/01/2008
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