Basic Information
| Provider Information | |||||||||
| NPI: | 1548299019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIR | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 STANLEY ST | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544811325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153441234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 DEWEY ST | ||||||||
| Address2: | |||||||||
| City: | WISCONSIN RAPIDS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544944715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154217430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 47344 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 43517000 | 05 | WI | MEDICAID |