Provider Demographics
NPI:1982792909
Name:WEIR, JAMES R
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:WEIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4462
Mailing Address - Country:US
Mailing Address - Phone:479-751-4609
Mailing Address - Fax:479-751-6519
Practice Address - Street 1:712 W MEADOW AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4462
Practice Address - Country:US
Practice Address - Phone:479-751-4609
Practice Address - Fax:479-751-6519
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B716OtherBLUE CROSS/BLUE SHIELD
AR35529OtherUNITED CONCORDIA