| Dr Lee Roy Wiederhold Iii, MD, PHD | |
|
301 University Blvd, Galveston, TX 77555-0462 | |
| (409) 772-2531 | |
| (409) 772-1814 |
| Full Name | Dr Lee Roy Wiederhold Iii |
|---|---|
| Gender | Male |
| Speciality | Radiation Oncology |
| Experience | 21 Years |
| Location | 301 University Blvd, Galveston, Texas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134323736 | NPI | - | NPPES |
| 213444702 | Medicaid | TX | |
| 3847415682 | Other | MYUTMB 3847415682-COMMERCIAL NUMBER | |
| 213444703 | Other | TX | MEDICAID CSHCN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0001X | Radiology - Radiation Oncology | M5976 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| University Of Texas Medical Branch Galveston | Galveston, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Utmb Faculty Group Practice | 3375456734 | 948 |
| Physicians Referral Service | 7911801410 | 2561 |
| Entity Name | Utmb Faculty Group Practice |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942241146 PECOS PAC ID: 3375456734 Enrollment ID: O20031112000438 |
| Entity Name | Physicians Referral Service |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073574810 PECOS PAC ID: 7911801410 Enrollment ID: O20031125000953 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Lee Roy Wiederhold Iii, MD, PHD 301 University Blvd, Galveston, TX 77555-5302 Ph: (409) 772-2222 | Dr Lee Roy Wiederhold Iii, MD, PHD 301 University Blvd, Galveston, TX 77555-0462 Ph: (409) 772-2531 |
Dr. Alvin Carlos Camacho, MD Radiology Medicare: Medicare Enrolled Practice Location: 301 University Blvd, Galveston, TX 77555 Phone: 409-772-4194 | |
Morton H. Leonard Jr., M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 38 Lakeview Dr, Galveston, TX 77551 Phone: 409-692-3345 | |
Dr. Roberto Nonesupplied Zamudio, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 301 University Blvd, Galveston, TX 77555 Phone: 409-772-4194 | |
Faustino C. Guinto Jr., M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 301 University Blvd, Galveston, TX 77555 Phone: 409-772-2222 | |
Dr. Eric Michael Walser, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: Department Of Radiology, 301 University Blvd, Galveston, TX 77555 Phone: 409-747-0100 Fax: 409-772-8219 | |
Gregory Chaljub, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 301 University Blvd, Galveston, TX 77555 Phone: 409-772-2222 | |
Tomas Eduardo Uribe Acosta, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 301 University Blvd, Galveston, TX 77555 Phone: 409-772-2222 |