Basic Information
| Provider Information | |||||||||
| NPI: | 1306931969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID J. WEIST, MD, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 994307 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960994307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302430498 | ||||||||
| FaxNumber: | 5302431309 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BUTTE STREET | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302430498 | ||||||||
| FaxNumber: | 5302431309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEIST | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5302430498 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A51285 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | A51285 | 01 | CA | CA STATE LICENSE # | OTHER |