Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 14403 | MS |
NPI | 1255447900 |
---|---|
Provider Name | Dr. Donald D. Weaver |
First Address | Walla Walla, WA 99362-2497 |
Second Address | Gulfport, MS 39501-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00114891 | (05) | MS |
110136321 | RAILROAD MEDICARE (01) | MS |
D75045 | (02) | MS |