Healthcare Provider Details

I. General information

NPI: 1922040963
Provider Name (Legal Business Name): JOHN CALVIN WEIR II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 VAIL AVE ANESTHESIA SERVICES
CHARLOTTE NC
28207-1219
US

IV. Provider business mailing address

PO BOX 60499 ANESTHESIA SERVICES
CHARLOTTE NC
28260-0499
US

V. Phone/Fax

Practice location:
  • Phone: 704-304-6202
  • Fax:
Mailing address:
  • Phone: 704-304-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number41167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: