Basic Information
Provider Information
NPI: 1366413346
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEG
FirstName: ALDEN
MiddleName: LYNN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1060 GAFFNEY RD #7440
Address2: COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM
City: FT. WAINWRIGHT
State: AK
PostalCode: 997037440
CountryCode: US
TelephoneNumber: 9073535418
FaxNumber: 9073534845
Practice Location
Address1: 1060 GAFFNEY RD #7440
Address2: BASSETT ARMY COMMUNITY HOSPITAL
City: FT. WAINWRIGHT
State: AK
PostalCode: 997037440
CountryCode: US
TelephoneNumber: 9073535418
FaxNumber: 9073534845
Other Information
ProviderEnumerationDate: 01/30/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X04-27514KSX Allopathic & Osteopathic PhysiciansFamily Medicine 
2083P0901X04-27514KSX Allopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine

No ID Information.


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