Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1192 | MS |
NPI | 1619236676 |
---|---|
Provider Name | Dr. Bradford Kimball Weathers |
First Address | Liberty, MS 39645-8029 |
Second Address | Liberty, MS 39645-8029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 20/02/2013 |