=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750368395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOB LEE WEEKS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 OAK ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-984-1800
-----------------------------------------------------
Fax | 513-984-4909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 OAK ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-984-1800
-----------------------------------------------------
Fax | 513-984-4909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1909
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------