Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1003965005 |
---|---|
Provider Name | Robert Weaver |
First Address | Raleigh, NC 27615-1160 |
Second Address | Raleigh, NC 27609-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795067 | (05) | NC |