Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | E-3438 | AR |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | E-3438 | AR |
NPI | 1528063997 |
---|---|
Provider Name | Terry Dean Weaver |
First Address | Wessington Springs, SD 57382-2163 |
Second Address | Wessington Springs, SD 57382-2163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD2018-0286 | NMMB LICENSE (01) | NM |