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General NPI Number Information
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NPI Number | 1710214036
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Entity Type | Organization
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Legal Business Name | GERALD E WEAVER MD PC
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 1511 CHARLES AVE
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City | WORLAND
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State | WY
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Zip | 82401-4122
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Country | US
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Telephone | 307-347-2405
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Fax | 307-347-3166
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Provider Business Mailing Address
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Address Line | 1511 CHARLES AVE
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City | WORLAND
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State | WY
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Zip | 82401-4122
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Country | US
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Telephone | 307-347-2405
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Fax | 307-347-3166
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD E WEAVER
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Credential | MD
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Telephone | 307-347-2405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 5731A
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License Number State | WY
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