Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 35053682 | OH |
NPI | 1003868530 |
---|---|
Provider Name | Jay S Weller |
First Address | Cleveland, OH 44195-0001 |
Second Address | Independence, OH 44131-2139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2268442 | (05) | OH |
C39661 | (02) | OH |