1184691859 NPI number — MRS. DANIELA V WEATHERLY MD

Table of content: MRS. DANIELA V WEATHERLY MD (NPI 1184691859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184691859 NPI number — MRS. DANIELA V WEATHERLY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERLY
Provider First Name:
DANIELA
Provider Middle Name:
V
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEATHERLY
Provider Other First Name:
DANIELA
Provider Other Middle Name:
VIORICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184691859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2147 RIVERCHASE OFFICE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-403-8902
Provider Business Mailing Address Fax Number:
205-982-0278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
MOBILE MEDICAL GROUP
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-342-6944
Provider Business Practice Location Address Fax Number:
251-342-4046
Provider Enumeration Date:
03/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  26258 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)