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NPI Code Detail

MEDICARE: JACKSON W WEAVER MD

MEDICARE: JACKSON W WEAVER MD
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
1207Q00000XFamily Medicine PhysicianE19265AR
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1467195016
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKSON W WEAVER MD
Provider Business Mailing Address
First Line : 1661 AIRPORT RD STE D
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-8184
Country : US
Telephone Number : 15-625-7500
Fax Number :
Provider Business Practice Location Address
First Line : 4517 PARK AVE
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71901-9476
Country : US
Telephone Number : 501-623-7900
Fax Number : 501-623-7337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2022
Last Update Date : 06/30/2025

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