MEDICARE: JERE H WEAVER M.D.

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	207N00000X	Dermatology Physician	11631	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	010050478	OTHER	AL	MEDICARE RAILROAD RETIREE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51025264	OTHER	AL	BLUE CROSS PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4585899	OTHER	AL	AETNA PROVIDER NUMBER
4	01-12771	OTHER	AL	UNITED HEALTH
6	515-97711	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1265436067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERE H WEAVER M.D.

Provider Business Mailing Address
First Line	:	722 BANK ST NE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-1610
Country	:	US
Telephone Number	:	256-351-1874
Fax Number	:	256-351-1876

Provider Business Practice Location Address
First Line	:	722 BANK ST NE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-1610
Country	:	US
Telephone Number	:	256-351-1874
Fax Number	:	256-351-1876

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/23/2013

Similar Medicare Providers

1851573778 — JERE H. WEAVER
Practice Location Address:

722 BANK ST NE
DECATUR, AL
35601-1610

Practice Phone: 256-351-1874
Practice Fax: 256-351-1876

1003819608 — ENCORE REHABILITATION, INC
Practice Location Address:

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Practice Phone: 256-340-9708
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1396748786 — CHARLES D WOODS JR. M.D.
Practice Location Address:

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DECATUR, AL
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1316942154 — NICHOLAS TILFORD BRASWELL IV M.D.
Practice Location Address:

1213 13TH AVE SE
DECATUR, AL
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Practice Fax: 256-973-3701

1568468833 — USA HEALTHCARE MORGAN LLC
Practice Location Address:

2326 MORGAN AVE SW
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1720084767 — USA HEALTHCARE MORGAN LLC
Practice Location Address:

2326 MORGAN AVE SW
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35601-6244

Practice Phone: 256-340-5765
Practice Fax: 256-340-1281

Directions to “ JERE H WEAVER M.D.” Practice Location

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