Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901018602 | MI |
NPI | 1033231238 |
---|---|
Provider Name | Dr. Brian Christopher Weaver |
First Address | Westerville, OH 43082-7988 |
Second Address | Westerville, OH 43082-7988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 21/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WE4219001 | MEDICARE ID (01) | OH |