Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN19403 | FL |
NPI | 1023305554 |
---|---|
Provider Name | Dr. James Patrick Weaver |
First Address | Jacksonville, FL 32257 |
Second Address | Jacksonville, FL 32259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 02/09/2020 |