Provider Demographics
NPI:1376286559
Name:WEAVER, JAKE THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:THOMAS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:269 GILLMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7923
Practice Address - Country:US
Practice Address - Phone:704-316-4930
Practice Address - Fax:704-316-4931
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2025-02249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine