Basic Information
| Provider Information | |||||||||
| NPI: | 1750324281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELLER | ||||||||
| FirstName: | SAMUEL DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951603 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930018 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 35 S TWIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST JEFFERSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431621442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148798141 | ||||||||
| FaxNumber: | 6148799949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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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 | 207Q00000X | 35-07-9160 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.