Glenn P. Wedeen MD a Medical Corporation

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G75574 Issued in CA

Legal business name

GLENN P. WEDEEN MD A MEDICAL CORPORATION

Practice address

15248 11TH St
Victorville, CA 92395-3704

Phone

(760) 245-8691

NPI assigned

Jan 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn P Wedeen, M.D.NPI 1275577504

Title

President

Phone

(626) 357-8535

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glenn P. Wedeen, M.D.

  • Diagnostic Radiology Physician
  • Victorville, CA
  • NPI 1275577504
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114063294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7630",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926077630",
            "telephone_number": "949-643-3345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15248 11TH ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953704",
            "telephone_number": "760-245-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN P. WEDEEN MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEDEEN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-357-8535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G75574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "G75574",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delaney Gist
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• Christal Lynn Glaser, DC
• Dominic Glass
• Glenn P. Matney, M.D., Inc.
• Glory Homes, Inc
• Curtis Godfrey
• Golden Age Medical Group, Inc
• Golden Years Elderly Care, Inc.
• Urbana Carmen Golden

• Diagnostic Radiology Physician in Victorville, CA
• Providers in Victorville, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.