Individual
BRENT R WEILERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3336 NORTH FUTRALL DRIVE, FAYETTEVILLE, AR 72703
(479) 463-3000
(479) 463-3050
Mailing address
12 E APPLEBY RD, CLINIC ADMINISTRATION, FAYETTEVILLE, AR 72703-3901
(479) 463-1704
(479) 463-7864
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
E-5218
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164614001
—
AR
01
—
5N836
BCBS
AR
01
—
P00405693
RR MCR
AR
Enumeration date
01/19/2007
Last updated
04/20/2010
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