=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144346206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAMBI R WEYERS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 02/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N16W24131 RIVERWOOD DRIVE
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-696-0696
-----------------------------------------------------
Fax | 262-696-0683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 677
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53187-0677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-696-0710
-----------------------------------------------------
Fax | 262-696-5680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 54042
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 54042-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------