Provider Demographics
NPI:1447321260
Name:DAVID J. WEIST, M.D., PROF. CORP.
Entity type:Organization
Organization Name:DAVID J. WEIST, M.D., PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WEIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-8654
Mailing Address - Street 1:292 IRONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5345
Mailing Address - Country:US
Mailing Address - Phone:530-246-7999
Mailing Address - Fax:
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:SRMC CENTER FOR WOUND CARE AND HYPERBARIC MEDICINE
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-229-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty