Provider Demographics
NPI:1942283734
Name:WEISMILLER, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:WEISMILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 516558
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 PINTO LN FL 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4195
Practice Address - Country:US
Practice Address - Phone:702-992-6888
Practice Address - Fax:702-992-6880
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600771207Q00000X
NV16710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86377OtherBCBS NC
NC8986377Medicaid
NC80106303OtherRAILROAD MEDICARE
NC8986377Medicaid
NC86377OtherBCBS NC