Provider Demographics
NPI:1740442409
Name:WEYER, JONATHAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:WEYER
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:PO BOX 3873
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3873
Mailing Address - Country:US
Mailing Address - Phone:812-490-3937
Mailing Address - Fax:
Practice Address - Street 1:120 SE 4TH ST STE 1300
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1607
Practice Address - Country:US
Practice Address - Phone:812-490-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070851A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000771428OtherANTHEM
IN000000771428OtherANTHEM