Healthcare Provider Details

I. General information

NPI: 1689669178
Provider Name (Legal Business Name): JAMES ROBERT WEIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date: 03/22/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

800 COOPER AVE. SUITE 12
SAGINAW MI
48602-5394
US

IV. Provider business mailing address

800 COOPER AVE. SUITE 12
SAGINAW MI
48602-5394
US

V. Phone/Fax

Practice location:
  • Phone: 989-754-7200
  • Fax: 989-754-2086
Mailing address:
  • Phone: 989-754-7200
  • Fax: 989-754-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberJW050199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: