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NPI Code Detail

MEDICARE: DR. JOHN THOMAS WEAVER D.O.

MEDICARE: DR. JOHN THOMAS WEAVER D.O.
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
1208600000XSurgery PhysicianJW008830MI

General Provider Information

NPI Number : 1437152634
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN THOMAS WEAVER D.O.
Provider Business Mailing Address
First Line : 1315 W AUSTIN BLVD
Second Line : APT B
City : NEVADA
State : MO
Zip : 64772-2803
Country : US
Telephone Number : 417-667-6119
Fax Number : 417-448-3643
Provider Business Practice Location Address
First Line : 800 S ASH ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3223
Country : US
Telephone Number : 417-448-3727
Fax Number : 417-448-3643
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/01/2026

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