Healthcare Provider Details

I. General information

NPI: 1396915047
Provider Name (Legal Business Name): JONATHAN ERNEST WEILER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 BLUEBONNET BLVD STE B
BATON ROUGE LA
70809-9675
US

IV. Provider business mailing address

4212 BLUEBONNET BLVD STE B
BATON ROUGE LA
70809-9675
US

V. Phone/Fax

Practice location:
  • Phone: 225-399-0001
  • Fax: 225-399-0008
Mailing address:
  • Phone: 225-399-0001
  • Fax: 225-399-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD.025994
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: