| Jack E Weaver, Md Pc | |
|
209 S 36th St Muskogee OK 74401-5043 | |
| (918) 682-7717 | |
| (918) 682-9434 |
| Full Name | Jack E Weaver, Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 209 S 36th St, Muskogee, Oklahoma |
| Authorized Official Name and Position | Jack E Weaver (OWNER) |
| Authorized Official Contact | 9186827717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack E Weaver, Md Pc 209 S 36th St Muskogee OK 74401-5043 Ph: (918) 682-7717 | Jack E Weaver, Md Pc 209 S 36th St Muskogee OK 74401-5043 Ph: (918) 682-7717 |
| NPI Number | 1841508918 |
|---|---|
| Provider Enumeration Date | 09/22/2010 |
| Last Update Date | 08/25/2015 |
| Medicare PECOS PAC ID | 6901096239 |
|---|---|
| Medicare Enrollment ID | O20100930098570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841508918 | NPI | - | NPPES |
| 100088830A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RS0010X | Internal Medicine - Sports Medicine | (* (Not Available)) | Primary |
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