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NPI Code Detail

MEDICARE: MR. JEFFREY D. WEERTMAN CRNA

MEDICARE: MR. JEFFREY D. WEERTMAN CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist640445TX

General Provider Information

NPI Number : 1487631685
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY D. WEERTMAN CRNA
Provider Business Mailing Address
First Line : 2309 FOREST PARK CIR
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-7643
Country : US
Telephone Number : 817-473-1329
Fax Number :
Provider Business Practice Location Address
First Line : 6501 HARRIS PARKWAY
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2122
Country : US
Telephone Number : 817-346-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 01/22/2008

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