MEDICARE: WILLIAM TRAVIS WEATHERS 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	208000000X	Pediatrics Physician	5116	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	576007863032	OTHER	SC	BCBS OF SC ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6356292	OTHER	SC	CIGNA ID

General Provider Information

NPI Number	:	1801837968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TRAVIS WEATHERS M.D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 SKYN DRIVE
Second Line	:	SUITE 240
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1069
Country	:	US
Telephone Number	:	864-598-0460
Fax Number	:	864-596-5164

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	11/24/2014

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Directions to “ WILLIAM TRAVIS WEATHERS M.D.” Practice Location

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