Basic Information
| Provider Information | |||||||||
| NPI: | 1013931013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEILAND | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | JEROME | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 SEVEN SPRINGS WAY | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159207000 | ||||||||
| FaxNumber: | 6159208775 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197760130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2009-00300 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 112076 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 2009-00300 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 206087603 | 05 | MO | MEDICAID | 1013931013 | 05 | NC | MEDICAID |