Healthcare Provider Details

I. General information

NPI: 1053334094
Provider Name (Legal Business Name): YVONNE JACKSON WEAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 BEAUFONT SPRINGS DR SUITE 100
RICHMOND VA
23225-5520
US

IV. Provider business mailing address

8001 FRANKLIN FARMS DR SUITE 130
RICHMOND VA
23229-5108
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-5011
  • Fax: 804-323-5120
Mailing address:
  • Phone: 804-521-5800
  • Fax: 804-545-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number0101025448
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101030305
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: