Provider Demographics
NPI:1851413140
Name:WEIR, ALVA B III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVA
Middle Name:B
Last Name:WEIR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2146
Mailing Address - Country:US
Mailing Address - Phone:901-606-0055
Mailing Address - Fax:901-322-2947
Practice Address - Street 1:100 N HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2146
Practice Address - Country:US
Practice Address - Phone:901-606-0055
Practice Address - Fax:901-322-2947
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9400207RH0003X
MS14222207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00583292Medicaid
TN4210048OtherBCBS TN
TN1508378Medicaid
AR1851413140OtherBCBS AR
MS$$$$$$$$$EOtherBCBS MS
TN1508378Medicaid
MS00583292Medicaid