Individual
KENNETH RAY WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
715 SHAKER DR STE 110, LEXINGTON, KY 40504-3674
(859) 313-5000
(859) 313-5002
Mailing address
715 SHAKER DR, SUITE 110, LEXINGTON, KY 40504-3674
(859) 313-5000
(859) 313-5002
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
23010
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000068949
BLUE CROSS BLUE SHIELD
KY
01
—
000000073116
BLUE CROSS
KY
01
—
611164546
UNITED HEALTHCARE
KY
05
—
64230105
—
KY
Enumeration date
07/07/2005
Last updated
08/03/2017
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