Provider Demographics
NPI:1356370795
Name:WEAVER, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STEAM PLANT RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-461-7335
Mailing Address - Fax:615-449-4835
Practice Address - Street 1:300 STEAM PLANT RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-461-7335
Practice Address - Fax:615-449-4835
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN56978207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034975Medicaid
AL200016925OtherRAILROAD MEDICARE
AL510-88135OtherBLUE CROSS
AL200410400OtherU S DEPARTMENT OF LABOR
AL0499960002Medicare NSC
AL000088135Medicare PIN
AL200016925OtherRAILROAD MEDICARE