Basic Information
| Provider Information | |||||||||
| NPI: | 1427378843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEIDENHAMMER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1925 W RIVER RD APT 1307 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737544801 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1921 W HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857047806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207422800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 25MA09886400 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 56680 | AZ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.