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General NPI Number Information
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NPI Number | 1467195016
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Entity Type | Individual
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Provider Name | JACKSON W WEAVER MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 4517 PARK AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-9476
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Country | US
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Telephone | 501-623-7900
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Fax | 501-623-7337
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Provider Business Mailing Address
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Address Line | 1661 AIRPORT RD STE D
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City | HOT SPRINGS
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State | AR
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Zip | 71913-8184
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Country | US
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Telephone | 15-625-7500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | E19265
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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