Provider Demographics
NPI:1588637649
Name:WEAVER, YAFFA K (MD)
Entity Type:Individual
Prefix:
First Name:YAFFA
Middle Name:K
Last Name:WEAVER
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 1:601 PROVIDENCE PARK DR E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4617
Mailing Address - Country:US
Mailing Address - Phone:251-650-1000
Mailing Address - Fax:251-650-1010
Practice Address - Street 1:601 PROVIDENCE PARK DR E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4617
Practice Address - Country:US
Practice Address - Phone:251-650-1000
Practice Address - Fax:251-650-1010
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21889207W00000X, 207WX0009X
FLME 67099207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000099586Medicaid
AL000099586Medicaid
G49728Medicare UPIN