Healthcare Provider Details

I. General information

NPI: 1558301614
Provider Name (Legal Business Name): WILLIAM LEE WEAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

4012 HEYWARD PL
INDIANAPOLIS IN
46250-4252
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-6301
  • Fax:
Mailing address:
  • Phone: 317-840-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01050939
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: