Provider Demographics
NPI:1982641106
Name:WEIMER, CARL EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:WEIMER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1240 21ST AVENUE N.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7431
Mailing Address - Country:US
Mailing Address - Phone:843-839-1414
Mailing Address - Fax:843-839-1413
Practice Address - Street 1:1240 21ST AVENUE N
Practice Address - Street 2:SUITE 106
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7431
Practice Address - Country:US
Practice Address - Phone:843-839-1414
Practice Address - Fax:843-839-1413
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11497207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC114977Medicaid
SCG016435401Medicare PIN
SCG016435216Medicare PIN
SC114977Medicaid