Provider Demographics
NPI:1568419513
Name:WEIBLE, NANCY ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:WEIBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 STONE HEDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4464
Mailing Address - Country:US
Mailing Address - Phone:601-299-0679
Mailing Address - Fax:
Practice Address - Street 1:6908 PROVIDENCE PARK DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-660-3490
Practice Address - Fax:251-660-3491
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12913207Q00000X
ALMD.30419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS080154729OtherMEDICARE RR INDIVIDUAL
MS5266238OtherAETNA INDIVIDUAL
MS00119477Medicaid
MS0130116OtherUNITED HEALTHCARE INDIVIDUAL
MS9015909OtherMEDICAID GROUP
MS0130116OtherUNITED HEALTHCARE INDIVIDUAL
MS$$$$$$$$$IOtherBLUE CROSS INDIVIDUAL
MS5266238OtherAETNA INDIVIDUAL
MS080003150Medicare PIN