Provider Demographics
NPI:1144346206
Name:WEYERS, BAMBI R (MD)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:R
Last Name:WEYERS
Suffix:
Gender:F
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:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53187-0677
Mailing Address - Country:US
Mailing Address - Phone:262-696-0710
Mailing Address - Fax:262-696-5680
Practice Address - Street 1:N16W24131 RIVERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-696-0696
Practice Address - Fax:262-696-0683
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI540422085R0001X
WI54042-202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000579033OtherANTHEM
IN000000579033OtherANTHEM