Provider Demographics
NPI:1013969989
Name:WEEKS, JEFFREY DAVID (US NAVY IDC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:WEEKS
Suffix:
Gender:M
Credentials:US NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-4840
Mailing Address - Country:US
Mailing Address - Phone:936-632-0618
Mailing Address - Fax:
Practice Address - Street 1:PSC 482 BOX 233
Practice Address - Street 2:
Practice Address - City:FPO AP
Practice Address - State:96602
Practice Address - Zip Code:6602
Practice Address - Country:JP
Practice Address - Phone:936-632-0618
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman