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General NPI Number Information
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NPI Number | 1487602710
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Entity Type | Individual
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Provider Name | MALCOLM WEATHERS MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 7TH ST SE
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City | DECATUR
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State | AL
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Zip | 35601-3337
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Country | US
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Telephone | 256-355-7133
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Fax | 256-350-6361
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Provider Business Mailing Address
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Address Line | PO BOX 2007
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City | DECATUR
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State | AL
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Zip | 35602-2007
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Country | US
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Telephone | 256-355-7133
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Fax | 256-350-6361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 16406
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License Number State | AL
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