Individual
DR. MARK W WEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7695 POPLAR PIKE, SUITE 101, GERMANTOWN, TN 38138-5947
(901) 685-2696
Mailing address
7695 POPLAR PIKE, SUITE 101, MEMPHIS, TN 38138-5947
(901) 685-2696
(901) 682-9747
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
12841
TN
2085R0204X
Vascular & Interventional Radiology Physician
10958
MS
2085R0204X
Vascular & Interventional Radiology Physician
Primary
12841
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3046111
—
TN
Enumeration date
05/31/2005
Last updated
08/03/2016
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