Provider Demographics
NPI:1013958370
Name:WEARY, KEVIN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:WEARY
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 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2607
Mailing Address - Country:US
Mailing Address - Phone:719-442-0808
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:SUITE 405
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-442-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0035276207VX0000X
CO35276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01352764Medicaid