Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 59618 | MN |
Y | 2080P0202X | Pediatric Cardiologist | 10358523-1205 | UT |
NPI | 1184032062 |
---|---|
Provider Name | Dr. Derek L. Weyhrauch |
First Address | Louisville, KY 40202 |
Second Address | Louisville, KY 40202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2014 |
Last Update Date | 12/07/2021 |