Individual
TED W WEATHERRED
Active
Individual
TED W WEATHERRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
034979
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000542165B
—
GA
05
—
000542165C
—
GA
01
—
050031131
RRMEDICARE
GA
01
—
339267
WELLCARE CMO
GA
01
—
480929
BCBS
GA
01
—
550789920
TRICARE
GA
05
—
G34979
—
SC
Enumeration date
11/13/2006
Last updated
06/15/2008
Update your record
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