Provider Demographics
NPI:1215049416
Name:WEAVER, SHARON R (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3462
Mailing Address - Country:US
Mailing Address - Phone:309-451-9595
Mailing Address - Fax:309-451-9583
Practice Address - Street 1:326 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3462
Practice Address - Country:US
Practice Address - Phone:309-451-9595
Practice Address - Fax:309-451-9583
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076443Medicaid
IL036076443Medicaid
IL575940Medicare ID - Type Unspecified