MEDICARE: DR. SHELLY RHODES WEISENFELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	21225	AL
2	207Q00000X	Family Medicine Physician	21225	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-96752	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1063444644	OTHER	AL	TRICARE SOUTH

General Provider Information

NPI Number	:	1063444644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY RHODES WEISENFELD MD

Provider Business Mailing Address
First Line	:	774 SHADES MOUNTAIN PLZ
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-1513
Country	:	US
Telephone Number	:	205-979-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 SHADES MOUNTAIN PLZ
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-1513
Country	:	US
Telephone Number	:	205-979-3381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/24/2023

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