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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-27514 | KS | X |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 2083P0901X | 04-27514 | KS | X |   | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.