MEDICARE: DONALD GREGORY WEATHERS 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	207QA0505X	Adult Medicine Physician	35044035	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407832918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD GREGORY WEATHERS M.D.

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	4TH FLOOR - ATTN: JUDY KORNMEIER
City	:	TOLEDO
State	:	OH
Zip	:	43604-7101
Country	:	US
Telephone Number	:	419-251-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	3949 SUNFOREST CT
Second Line	:	SUITE 202
City	:	TOLEDO
State	:	OH
Zip	:	43623-4473
Country	:	US
Telephone Number	:	419-474-1111
Fax Number	:	419-474-1255

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	09/10/2014

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