Healthcare Provider Details

I. General information

NPI: 1962681866
Provider Name (Legal Business Name): JIM CHRISTIE WEIR JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2714
US

IV. Provider business mailing address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2714
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8336
  • Fax:
Mailing address:
  • Phone: 504-941-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberP-30
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: