Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101261879 | VA |
N | 207Q00000X | Family Doctor | 21733 | WV |
N | 207Q00000X | Family Doctor | 3584922 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 0101261879 | VA |
NPI | 1245342765 |
---|---|
Provider Name | Paul Daniel Weidman |
First Address | South Hill, VA 23970-0623 |
Second Address | South Hill, VA 23970-1614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001712686 | MS BLUE CROSS BLUE SHIELD (01) | WV |
2513917 | (05) | OH |
3810001239 | (05) | WV |
I22787 | (02) | |
P00220382 | RAILROAD MEDICARE (01) |