Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | F5412 | TX |
NPI | 1043211337 |
---|---|
Provider Name | Dr. Elliott Russell Weidman |
First Address | Houston, TX 77054-1920 |
Second Address | Houston, TX 77054-1920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B27462 | (02) |