Provider Demographics
NPI:1326131525
Name:WEATHERFORD, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:WEATHERFORD
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 1:1411 PHYSICIANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7338
Mailing Address - Country:US
Mailing Address - Phone:910-343-0811
Mailing Address - Fax:910-343-5719
Practice Address - Street 1:1411 PHYSICIANS DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7338
Practice Address - Country:US
Practice Address - Phone:910-343-0811
Practice Address - Fax:910-343-5719
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-004172086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1030NOtherBCBS OF NC INDIVIDUAL #
NC89-1030NMedicaid
NC891030NMedicaid
NC02003617OtherRAILROAD MEDICARE INDV #
NC1030NOtherBCBS OF NC
NC1205252OtherINDV. UNITED HEALTHCARE #
NC1030NOtherBCBS OF NC
F65454Medicare UPIN
NC1205252OtherINDV. UNITED HEALTHCARE #