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General NPI Number Information
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NPI Number | 1063583904
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Entity Type | Organization
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Legal Business Name | JACK T WEAVER DPM DO MD PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 3120 CORRINE DR
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City | ORLANDO
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State | FL
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Zip | 32803-2206
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Country | US
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Telephone | 407-894-1931
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Fax | 407-894-5919
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Provider Business Mailing Address
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Address Line | 3120 CORRINE DR
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City | ORLANDO
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State | FL
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Zip | 32803-2206
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Country | US
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Telephone | 407-894-1931
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Fax | 407-894-5919
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. HOWARD D WEAVER
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Credential | DO
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Telephone | 407-894-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS0005348
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS0004936
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License Number State | FL
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