MEDICARE: DR. PATRICIA DOCKERY WEAVIL 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	2080P0006X	Developmental - Behavioral Pediatrics Physician	26478	NC

General Provider Information

NPI Number	:	1396823498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA DOCKERY WEAVIL MD

Provider Business Mailing Address
First Line	:	4805 SEWARD RD
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-9450
Country	:	US
Telephone Number	:	336-722-7077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 SEWARD RD
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-9450
Country	:	US
Telephone Number	:	336-722-7077
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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