Provider Demographics
NPI:1689653578
Name:WEAVER, PAUL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1690 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1052
Mailing Address - Country:US
Mailing Address - Phone:864-582-1201
Mailing Address - Fax:864-596-7409
Practice Address - Street 1:1690 SKYLYN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1022
Practice Address - Country:US
Practice Address - Phone:864-582-1201
Practice Address - Fax:864-596-7409
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1628Medicaid
SCGP1628Medicaid
SC9654Medicare ID - Type Unspecified
D56698Medicare UPIN