MEDICARE: JEFFREY GRANT WEYENETH MD

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
1	2084P0800X	Psychiatry Physician	35123	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912991944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GRANT WEYENETH MD

Provider Business Mailing Address
First Line	:	PO BOX 2689
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52809-2689
Country	:	US
Telephone Number	:	563-271-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 W CENTRAL PARK AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1707
Country	:	US
Telephone Number	:	563-328-5690
Fax Number	:	563-328-5690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	04/21/2009

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