Provider Demographics
NPI:1225148877
Name:WEAVER, WALTER DAN (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DAN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW CORPORATE VIEW
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1233
Mailing Address - Country:US
Mailing Address - Phone:785-235-3322
Mailing Address - Fax:785-246-6258
Practice Address - Street 1:619 SW CORPORATE VIEW
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1233
Practice Address - Country:US
Practice Address - Phone:785-235-3322
Practice Address - Fax:785-246-6258
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-14491207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS049567OtherBCBS OF KS
KSB68226Medicare UPIN
KS049567Medicare ID - Type UnspecifiedMEDICARE