Provider Demographics
NPI:1528064441
Name:WEIR, DAVID LOUIS (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LOUIS
Last Name:WEIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E FARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7208
Mailing Address - Country:US
Mailing Address - Phone:337-504-3215
Mailing Address - Fax:337-504-4032
Practice Address - Street 1:802 E FARREL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7208
Practice Address - Country:US
Practice Address - Phone:337-504-4039
Practice Address - Fax:337-504-4032
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1374571Medicaid
LAB65463Medicare UPIN
LA54836Medicare ID - Type Unspecified