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General NPI Number Information
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NPI Number | 1154419802
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Entity Type | Organization
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Legal Business Name | DOCTORS WEAVER & WEAVER P C
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 5304 INDIAN GRAVE RD SW SUITE A
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City | ROANOKE
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State | VA
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Zip | 24018-9108
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Country | US
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Telephone | 540-772-7107
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Fax | 540-772-7858
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Provider Business Mailing Address
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Address Line | 5304 INDIAN GRAVE RD SW SUITE A
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City | ROANOKE
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State | VA
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Zip | 24018-9108
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Country | US
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Telephone | 540-772-7107
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Fax | 540-772-7858
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DONNA C SEBESTIN
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Credential |
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Telephone | 540-772-7107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 0101033189
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License Number State | VA
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