Basic Information
| Provider Information | |||||||||
| NPI: | 1235365990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEIGLE | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | QUINN | ||||||||
| OtherFirstName: | KERI | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1213 24TH ST | ||||||||
| Address2: | STE 700 | ||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102679593 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLZ | ||||||||
| Address2: | SUITE 8501 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900959593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102679593 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | A130738 | CA | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | MD60918827 | WA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.