Provider Demographics
NPI:1912197146
Name:WEILY, WILLIAM JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:WEILY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:WV
Mailing Address - Zip Code:25909-0365
Mailing Address - Country:US
Mailing Address - Phone:304-487-9442
Mailing Address - Fax:330-536-0069
Practice Address - Street 1:6007 US ROUTE 60 E STE 228
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1042
Practice Address - Country:US
Practice Address - Phone:304-487-9442
Practice Address - Fax:330-536-0069
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006026213ES0103X
WV10477213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWVB423AOtherWV MEDICARE