Provider Demographics
NPI:1912954587
Name:WEAVER, JOSEPH GIFFORD III (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GIFFORD
Last Name:WEAVER
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CENTER ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3045
Mailing Address - Country:US
Mailing Address - Phone:336-243-2973
Mailing Address - Fax:336-243-2973
Practice Address - Street 1:208 W CENTER ST
Practice Address - Street 2:SUITE D
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3045
Practice Address - Country:US
Practice Address - Phone:336-243-2973
Practice Address - Fax:336-243-2973
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2207761OtherCIGNA HEALTHCARE ID #
2709191OtherEVERCARE ID
NC890818BMedicaid
NC0818BOtherBCBS ID
NC243123Medicare ID - Type Unspecified
NC0818BOtherBCBS ID