1598779720 NPI number — DR. WEIDUN ALAN GUO MD

Table of content: DR. WEIDUN ALAN GUO MD (NPI 1598779720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598779720 NPI number — DR. WEIDUN ALAN GUO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUO
Provider First Name:
WEIDUN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598779720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8000 DEPT 313
Provider Second Line Business Mailing Address:
UNIVERSITY AT BUFFALO SURGEONS, INC.
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14267-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-888-4889
Provider Business Mailing Address Fax Number:
716-849-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 GRIDER ST
Provider Second Line Business Practice Location Address:
DEPT OF SURGERY
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-898-5186
Provider Business Practice Location Address Fax Number:
716-898-3194
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X , with the licence number:  240872 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02806664 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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