Individual
DR. BARRY CRAIG WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3506
(309) 663-2354
(309) 662-8602
Mailing address
306 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3506
(309) 663-2354
(309) 662-8602
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036078523
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078523
—
IL
Enumeration date
05/05/2006
Last updated
07/29/2013
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