Provider Demographics
NPI:1730287475
Name:WEIMER, BRUCE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAMES
Last Name:WEIMER
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 1:412 W CARROLL AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4240
Mailing Address - Country:US
Mailing Address - Phone:626-914-4111
Mailing Address - Fax:
Practice Address - Street 1:412 W CARROLL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4240
Practice Address - Country:US
Practice Address - Phone:626-914-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG548722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G548720Medicaid
CA00G548720Medicaid
CAA93329Medicare UPIN