Provider Demographics
NPI:1265436067
Name:WEAVER, JERE H (MD)
Entity type:Individual
Prefix:
First Name:JERE
Middle Name:H
Last Name:WEAVER
Suffix:
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 1:722 BANK ST NE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-1610
Mailing Address - Country:US
Mailing Address - Phone:256-351-1874
Mailing Address - Fax:256-351-1876
Practice Address - Street 1:722 BANK ST NE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-1610
Practice Address - Country:US
Practice Address - Phone:256-351-1874
Practice Address - Fax:256-351-1876
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11631207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51025264OtherBLUE CROSS PROVIDER NUMBE
AL009912888Medicaid
AL4585899OtherAETNA PROVIDER NUMBER
AL01-12771OtherUNITED HEALTH
AL010050478OtherMEDICARE RAILROAD RETIREE
AL515-97711OtherBCBS
AL010050478OtherMEDICARE RAILROAD RETIREE
AL51025264OtherBLUE CROSS PROVIDER NUMBE