MEDICARE: ROXANE WEIGHALL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34-007205	OH
2	2086X0206X	Surgical Oncology Physician	34-007205	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000955123	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7900369	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1497711493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANE WEIGHALL DO

Provider Business Mailing Address
First Line	:	3700 SOUTHERN BLVD STE 201
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:	855-500-2873
Fax Number	:	937-281-3992

Provider Business Practice Location Address
First Line	:	3700 SOUTHERN BLVD STE 201
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:	855-500-2873
Fax Number	:	937-281-3992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/16/2020

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Directions to “ ROXANE WEIGHALL DO” Practice Location

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