Individual
LEROY D WEAVER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 W EDISON RD, STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Mailing address
620 W EDISON RD, STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01060476A
IN
2085N0700X
Neuroradiology Physician
01060476A
IN
2085N0904X
Nuclear Radiology Physician
01060476A
IN
2085P0229X
Pediatric Radiology Physician
01060476A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
01060476A
IN
2085R0203X
Therapeutic Radiology Physician
01060476A
IN
2085R0204X
Vascular & Interventional Radiology Physician
01060476A
IN
2085U0001X
Diagnostic Ultrasound Physician
01060476A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200809390
—
IN
Enumeration date
02/07/2006
Last updated
05/16/2013
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