MEDICARE: WALTER DAN WEAVER M.D.

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	207W00000X	Ophthalmology Physician	04-14491	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049567	OTHER	KS	BCBS OF KS

General Provider Information

NPI Number	:	1225148877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER DAN WEAVER M.D.

Provider Business Mailing Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

Provider Business Practice Location Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/24/2008

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