Healthcare Provider Details

I. General information

NPI: 1467738955
Provider Name (Legal Business Name): DAVID WEILER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 JEFFERSON ST SUITE 112
AUSTIN TX
78731-6225
US

IV. Provider business mailing address

3724 JEFFERSON ST SUITE 112
AUSTIN TX
78731-6225
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9700
  • Fax: 512-407-9511
Mailing address:
  • Phone: 512-454-9700
  • Fax: 512-407-9511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE8227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: