MEDICARE: DAVID J WEAVER M.D.

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	174400000X	Specialist
2	207T00000X	Neurological Surgery Physician	01060207A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679578504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J WEAVER M.D.

Provider Business Mailing Address
First Line	:	2200 E PARRISH AVE
Second Line	:	BLDG D SUITE 100
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1449
Country	:	US
Telephone Number	:	270-688-1770
Fax Number	:	270-688-1781

Provider Business Practice Location Address
First Line	:	2200 E PARRISH AVE
Second Line	:	BLDG D SUITE 100
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1449
Country	:	US
Telephone Number	:	270-688-1770
Fax Number	:	270-688-1781

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/20/2014

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Directions to “ DAVID J WEAVER M.D.” Practice Location

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