Provider Demographics
NPI:1134449366
Name:WEESE, KAYLAN LAWSON (MD)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:LAWSON
Last Name:WEESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAYLAN
Other - Middle Name:LEIGH
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2440 NW EDENBOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8847
Mailing Address - Country:US
Mailing Address - Phone:541-957-1141
Mailing Address - Fax:
Practice Address - Street 1:2440 NW EDENBOWER BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8847
Practice Address - Country:US
Practice Address - Phone:541-957-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG163762207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology