DR. LEE ROY WIEDERHOLD III (NPI# 1134323736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134323736 |
| Entity Type | Individual |
| Full Name | DR. LEE ROY WIEDERHOLD III |
| Credential | MD, PHD |
| Practice Address |
301 University Blvd Galveston TX 77555-0462 |
| Mailing Address |
301 University Blvd Galveston TX 77555-5302 |
| Practice Telephone | 4097722531 |
| Practice Fax Number | 4097721814 |
| Mailing Telephone | 4097722222 |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2019-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
M5976 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MYUTMB 3847415682-COMMERCIAL NUMBER | 3847415682 | 01 | |
| TX | MEDICAID CSHCN | 213444703 | 01 |
| TX | 213444702 | 05 |
| Street Address |
301 UNIVERSITY BLVD |
| City | GALVESTON |
| State | TX |
| Zip Code | 77555-0462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396742714 | Bagi Rp Jana | Internal Medicine | 301 University Blvd, Galveston, TX 77555-0565 | 2005-06-30 |
| 1023617685 | Kimberly Joy Staton | Nurse Practitioner | 301 University Blvd, Galveston, TX 77555-5303 | 2020-10-23 |
| 1295333185 | Adelina Mun See Leong | Physician Assistant | 301 University Blvd, Galveston, TX 77555-3205 | 2020-10-13 |
| 1245838341 | Zachary Allen Helmick | Physician Assistant | 301 University Blvd, Galveston, TX 77555-5302 | 2020-10-12 |
| 1477150795 | Mason Juehon Yu | Physician Assistant | 301 University Blvd, Galveston, TX 77555-5302 | 2020-10-09 |
| 1336746866 | Hillary Mai | Physician Assistant | 301 University Blvd, Galveston, TX 77555-5302 | 2020-10-07 |
| 1699380139 | Sanjai Naicheril Sabu | Physician Assistant | 301 University Blvd, Galveston, TX 77555-5302 | 2020-09-11 |
| 1497369409 | Olusola Sogbein | Internal Medicine | 301 University Blvd, Galveston, TX 77555-0562 | 2020-09-08 |
| 1801409636 | Anand Kumar | Internal Medicine | 301 University Blvd, Galveston, TX 77555-0100 | 2020-08-31 |
| 1235748633 | Youlanda Martin-jones | Family Medicine | 301 University Blvd, Galveston, TX 77555-5302 | 2020-07-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053963389 | Ruba Riachy | Internal Medicine | The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 | 2019-07-16 |
| 1700362670 | Nidal Alhosainat | Internal Medicine | 301 University Blvd, 4.200 John Sealy Annex, Galveston, TX 77555 | 2018-07-13 |
| 1275915282 | Murtaza Mazhar | Internal Medicine | 301 University Blvd Cardiovascular Disease, Galveston, TX 77555 | 2015-06-25 |
| 1124469531 | Nisarg Shaileshbhai Shah | Internal Medicine | 400 Harborside Dr Suite #100, Endocrinology, Galveston, TX 77555 | 2013-07-13 |
| 1912260860 | Mohammed Fathi Zaidan | Internal Medicine | University of Texas Medical, 301 University Boulevard, Galveston, TX 77555 | 2012-06-15 |
| 1639465925 | Justin Blinn | Anesthesiology | 301 University Blvd # 2-a, Galveston, TX 77555 | 2011-06-24 |
| 1255532982 | Miguel Mauricio Cabada Samame | Internal Medicine | 301 University Boulevard Rt 0435, Galveston, TX 77555 | 2007-05-30 |
| 1154945608 | Elliot Blankespoor | Anesthesiology | 301 University Boulevard, 5.504 Jennie Sealy Hospital, Galveston, TX 77555 | 2020-06-01 |
| 1932699972 | Sara Medsker | Pediatrics | 301 University Blvd., Galveston, TX 77555 | 2018-05-15 |
| 1134297666 | Donna B Weaver | Family Medicine | 400 Harborside Dr, Galveston, TX 77555 | 2006-12-01 |
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| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295781078 | Shailesh Gupta | Radiology | 12 Cadena Dr, Galveston, TX 77554-6329 | 2006-05-25 |
| 1689038051 | Jay Messer | Radiology | 301 University Blvd, 1.400 Mccullough Building, Galveston, TX 77555-1501 | 2016-04-11 |
| 1689856874 | Melissa M. Joyner | Radiology | 301 University Blvd, Galveston, TX 77555-5302 | 2007-11-29 |
| 1750595310 | Todd Swanson | Radiology | 301 University Blvd, Galveston, TX 77555-0711 | 2007-05-10 |
| 1124180690 | Sandra S Hatch | Radiology | 301 University Blvd, Galveston, TX 77555-5302 | 2006-12-14 |
| 1174685630 | Martin Colman | Radiology | 301 University Blvd, Galveston, TX 77555-5302 | 2006-12-14 |
| 1407918980 | Ivan Kessel | Radiology | 301 University Blvd, Galveston, TX 77555-5302 | 2006-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376154534 | Genesiscare Landmark Texas Cancer Care Pa | Radiology | 12606 Greenville Ave Ste 160, Dallas, TX 75243-1915 | 2020-08-12 |
| 1780232090 | Yaser Hasan | Radiology | 1911 Holcombe Blvd Apt 1615, Houston, TX 77030-4190 | 2019-08-29 |
| 1932557030 | Joseph Charles Arko | Radiology | 11532 Champions Green Dr, Houston, TX 77066-1070 | 2016-05-30 |
| 1962860221 | Urology San Antonio, P.a. | Radiology | 7718 Pasteur Dr, San Antonio, TX 78229-3402 | 2016-02-02 |
| 1619355419 | Jamie Pawlowski | Radiology | 2215 E Villa Maria Rd Ste 130, Bryan, TX 77802-2585 | 2015-05-12 |
| 1073915245 | Texas Radiation Oncology Medical Group, Pllc | Radiology | 2800 State Hwy 114 East, Suite 100, Trophy Club, TX 76262 | 2014-09-19 |
| 1548660186 | Century West Houston Pllc | Radiology | 2610 W Sam Houston Pkwy S, Houston, TX 77042-0008 | 2014-09-02 |
| 1275971533 | Corsicana Cancer Center | Radiology | 306 Hospital Dr., Corsicana, TX 75110 | 2013-06-10 |
| 1194079376 | Century Radiation Oncology Lubbock, Pllc | Radiology | 424 N. Utica, Lubbock, TX 79416-3035 | 2012-11-09 |
| 1285999698 | Robert Dery Lindberg | Radiology | 3757 Robinhood St, Houston, TX 77005-2027 | 2012-07-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.