MEDICARE: DEBORAH ANNE WEYER 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
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	ME78720	FL
2	208000000X	Pediatrics Physician	ME78720	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58539	OTHER	FL	BC
2	ME78720	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871524181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANNE WEYER MD

Provider Business Mailing Address
First Line	:	1658 ST VINCENT'S WAY
Second Line	:	SUITE 320
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-8459
Country	:	US
Telephone Number	:	904-602-4330
Fax Number	:	904-602-4371

Provider Business Practice Location Address
First Line	:	1658 ST VINCENT'S WAY
Second Line	:	SUITE 320
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-8459
Country	:	US
Telephone Number	:	904-602-4330
Fax Number	:	904-602-4371

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/09/2014

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Directions to “ DEBORAH ANNE WEYER MD” Practice Location

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