Provider Demographics
NPI:1285663989
Name:WEAVER, LANCE DELANEY (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:DELANEY
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 1:300 STEAM PLANT RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-452-7574
Mailing Address - Fax:615-452-8688
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:SUITE 420
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-452-7574
Practice Address - Fax:615-452-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3087800Medicare PIN