Healthcare Provider Details

I. General information

NPI: 1679578504
Provider Name (Legal Business Name): DAVID J WEAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG D SUITE 100
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG D SUITE 100
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-1770
  • Fax: 270-688-1781
Mailing address:
  • Phone: 270-688-1770
  • Fax: 270-688-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01060207A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: