Individual
KENNETH RAY WEAVER
Active
Individual
KENNETH RAY WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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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