Healthcare Provider Details

I. General information

NPI: 1255690749
Provider Name (Legal Business Name): DANIEL TIMOTHY WEAVER MB BCH BAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK DIV OF HOSPITAL MEDICINE 800 ROSE ST, MN604
LEXINGTON KY
40536-0298
US

IV. Provider business mailing address

UK DIV OF HOSPITAL MEDICINE 800 ROSE ST, MN604
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6047
  • Fax: 859-257-3873
Mailing address:
  • Phone: 859-323-6047
  • Fax: 859-257-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48071
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number48071
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: