Provider Demographics
NPI:1356340327
Name:WEAVER, DAVID L JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1903
Mailing Address - Fax:580-548-1434
Practice Address - Street 1:601 W GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5524
Practice Address - Country:US
Practice Address - Phone:580-977-1903
Practice Address - Fax:580-548-1434
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-02-12
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Provider Licenses
StateLicense IDTaxonomies
OK23176207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100845660AMedicaid
OK244405601Medicare PIN
OK100845660AMedicaid