Individual
DONALD J. WEIDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 N MAIN ST, TOMPKINSVILLE, KY 42167-1002
(270) 407-5052
(270) 407-5053
Mailing address
PO BOX 669, TOMPKINSVILLE, KY 42167-0669
(270) 407-5052
(270) 407-5053
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38570
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000356155
ANTHEM PIN
KY
05
—
64078371
—
KY
01
—
810529995
TRICARE
—
Enumeration date
07/26/2006
Last updated
11/03/2020
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