Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 20676 | NE |
NPI | 1003929258 |
---|---|
Provider Name | Dr. Deborah R. Weaver |
First Address | North Platte, NE 69101-5411 |
Second Address | North Platte, NE 69101-5411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 07/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063678 | BC BS (01) | NE |