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General NPI Number Information
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NPI Number | 1699828186
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Entity Type | Individual
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Provider Name | BRENT R WEILERT MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 3336 NORTH FUTRALL DRIVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-463-3000
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Fax | 479-463-3050
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Provider Business Mailing Address
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Address Line | 12 E APPLEBY RD CLINIC ADMINISTRATION
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3901
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Country | US
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Telephone | 479-463-1704
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Fax | 479-463-7864
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | E-5218
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License Number State | AR
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