Provider Demographics
NPI:1538350830
Name:WEIMAR, JAMES DUDLEY (MD, PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DUDLEY
Last Name:WEIMAR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:DUDLEY
Other - Last Name:WEIMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:3223 N WEBB RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8175
Mailing Address - Country:US
Mailing Address - Phone:316-609-2600
Mailing Address - Fax:316-609-2867
Practice Address - Street 1:3223 N WEBB RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8175
Practice Address - Country:US
Practice Address - Phone:316-609-2600
Practice Address - Fax:316-609-2867
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33992207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200626130AMedicaid