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Individual

ANTHONY D WEAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
60 MACK WALTERS RD, SHELBYVILLE, KY 40065-1738
(502) 633-4622
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24528
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000186862
BLUE CROSS INDIVIDUAL
KY
05
64245285
KY
05
65906844
KY
Enumeration date
08/31/2006
Last updated
08/03/2020
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