1538350830 NPI number — JAMES DUDLEY WEIMAR M.D., PH.D.

Table of content: JAMES DUDLEY WEIMAR M.D., PH.D. (NPI 1538350830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538350830 NPI number — JAMES DUDLEY WEIMAR M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIMAR
Provider First Name:
JAMES
Provider Middle Name:
DUDLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIMAR
Provider Other First Name:
JAY
Provider Other Middle Name:
DUDLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538350830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3223 N WEBB RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67226-8175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-609-2600
Provider Business Mailing Address Fax Number:
316-609-2867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3223 N WEBB RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-8175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-609-2600
Provider Business Practice Location Address Fax Number:
316-609-2867
Provider Enumeration Date:
08/05/2007

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: 207T00000X , with the licence number:  04-33992 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200626130A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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