Provider Demographics
NPI:1841200037
Name:WEIR, KURT D (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:D
Last Name:WEIR
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 1:2708 SW 125TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4759
Mailing Address - Country:US
Mailing Address - Phone:405-378-0724
Mailing Address - Fax:
Practice Address - Street 1:1240 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3604
Practice Address - Country:US
Practice Address - Phone:405-631-1527
Practice Address - Fax:405-631-9930
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18441208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108030AMedicaid
OK100108030AMedicaid
OKG24697Medicare UPIN