Individual
JOHN ROUSE WEATHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 STADIUM OAKS DR, CLEMMONS, NC 27012-8962
(336) 766-0547
(336) 766-0549
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 766-0547
(336) 766-0549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2012-00190
NC
208000000X
Pediatrics Physician
2012-00190
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5920486
—
NC
Enumeration date
06/23/2008
Last updated
10/28/2020
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