Provider Demographics
NPI:1417902354
Name:WEYER, JASON CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:WEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N C AVE
Mailing Address - Street 2:PO BOX 1327
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-2410
Mailing Address - Country:US
Mailing Address - Phone:307-864-8207
Mailing Address - Fax:307-864-9470
Practice Address - Street 1:120 N C AVE
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2410
Practice Address - Country:US
Practice Address - Phone:307-864-8207
Practice Address - Fax:307-864-9470
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7347A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123460900Medicaid
WYP00436280OtherRAILROAD MEDICARE
WY112JCW06OtherWY CONTROLLED SUBSTANCE #
WYWY7347AOtherWY MEDICAIL LICENSE #
WYBW7433321OtherDEA
WY112JCW06OtherWY CONTROLLED SUBSTANCE #
WYI56030Medicare UPIN