Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 57285 | TN |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 57285 | TN |
NPI | 1013278084 |
---|---|
Provider Name | Dr. William Jacob Weller |
First Address | Germantown, TN 38138-2205 |
Second Address | Southaven, MS 38671-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 03/11/2020 |