Healthcare Provider Details

I. General information

NPI: 1932293222
Provider Name (Legal Business Name): MICHAEL THOMAS WEAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 PRYTANIA ST STE 400
NEW ORLEANS LA
70115-3761
US

IV. Provider business mailing address

3600 PRYTANIA ST STE 35
NEW ORLEANS LA
70115-3628
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-8276
  • Fax: 504-897-8336
Mailing address:
  • Phone: 504-897-8315
  • Fax: 504-891-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number019166
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD.019166
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: