Healthcare Provider Details

I. General information

NPI: 1710974944
Provider Name (Legal Business Name): DAVE DREW WEEMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W SAGAMORE AVE OFC
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

132 RIDGE ROCK DR
RUSSELLVILLE AR
72802-2226
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-3434
  • Fax:
Mailing address:
  • Phone: 417-761-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS21357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114747
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-5759
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE5759
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: