Provider Demographics
NPI:1366183592
Name:WEGER, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9437 PRAIRIE DOG DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2081
Mailing Address - Country:US
Mailing Address - Phone:402-212-3523
Mailing Address - Fax:
Practice Address - Street 1:6516 N OLIE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7226
Practice Address - Country:US
Practice Address - Phone:405-608-8060
Practice Address - Fax:405-608-8070
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily