Provider Demographics
NPI:1851461339
Name:WEEKS, LIONEL EDWARDS (MD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:EDWARDS
Last Name:WEEKS
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 1:210 E 300 S
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2622
Mailing Address - Country:US
Mailing Address - Phone:435-719-5550
Mailing Address - Fax:435-719-5551
Practice Address - Street 1:476 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2065
Practice Address - Country:US
Practice Address - Phone:435-719-5550
Practice Address - Fax:435-719-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0519910220207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT05199Medicaid
UTC63802Medicare UPIN
UT05199Medicaid