Provider Demographics
NPI:1407832918
Name:WEATHERS, DONALD GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GREGORY
Last Name:WEATHERS
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 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR - ATTN: JUDY KORNMEIER
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-1963
Mailing Address - Fax:
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-474-1111
Practice Address - Fax:419-474-1255
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044035207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400702Medicaid
OH0464873Medicare ID - Type Unspecified
OH0400702Medicaid