Provider Demographics
NPI:1487631685
Name:WEERTMAN, JEFFREY D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:WEERTMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7643
Mailing Address - Country:US
Mailing Address - Phone:817-473-1329
Mailing Address - Fax:
Practice Address - Street 1:6501 HARRIS PARKWAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2122
Practice Address - Country:US
Practice Address - Phone:817-346-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640445367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14252Medicare UPIN
TX8G0427Medicare PIN
TX8G0871Medicare ID - Type Unspecified607K