Bruce James Weimer, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

G54872 Issued in CA

Practice address

412 W Carroll Ave
Suite 203
Glendora, CA 91741-4240

Phone

(626) 914-4111

NPI assigned

Sep 20, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1730287475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 W CARROLL AVE",
            "address_2": "SUITE 203",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414240",
            "telephone_number": "626-914-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W CARROLL AVE",
            "address_2": "SUITE 203",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414240",
            "telephone_number": "626-914-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIMER",
        "first_name": "BRUCE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G54872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G548720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Glendora, CA
• Providers in Glendora, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.