Provider Demographics
NPI:1629058136
Name:WEEKS, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:WEEKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8176 CROSSGATE CT N
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8431
Mailing Address - Country:US
Mailing Address - Phone:614-889-6262
Mailing Address - Fax:614-799-8056
Practice Address - Street 1:921 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2020
Practice Address - Country:US
Practice Address - Phone:419-673-0761
Practice Address - Fax:419-673-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7234-W207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206151Medicaid
OH000000198246OtherBLUECROSS BLUESHIELD
OH4124256Medicare PIN
OH000000198246OtherBLUECROSS BLUESHIELD
H17167Medicare UPIN
OHWE4124253Medicare PIN