Healthcare Provider Details

I. General information

NPI: 1407832918
Provider Name (Legal Business Name): DONALD GREGORY WEATHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 SUNFOREST CT SUITE 202
TOLEDO OH
43623-4473
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FLOOR - ATTN: JUDY KORNMEIER
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-1111
  • Fax: 419-474-1255
Mailing address:
  • Phone: 419-251-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35044035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: