Healthcare Provider Details

I. General information

NPI: 1417484759
Provider Name (Legal Business Name): DEXTER WEEKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST UNIT 710
LOUISVILLE KY
40202-5707
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD STE 3200
COLUMBUS OH
43212-3167
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-8303
  • Fax:
Mailing address:
  • Phone: 614-685-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number57.254077
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberBP10060964
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberTP191
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: