| Jack T Weaver Dpm Do Md Pa | |
|
3120 Corrine Dr Orlando FL 32803-2206 | |
| (407) 894-1931 | |
| (407) 894-5919 |
| Full Name | Jack T Weaver Dpm Do Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 3120 Corrine Dr, Orlando, Florida |
| Authorized Official Name and Position | Howard D Weaver (PHYSICIAN) |
| Authorized Official Contact | 4078941931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack T Weaver Dpm Do Md Pa 3120 Corrine Dr Orlando FL 32803-2206 Ph: (407) 894-1931 | Jack T Weaver Dpm Do Md Pa 3120 Corrine Dr Orlando FL 32803-2206 Ph: (407) 894-1931 |
| NPI Number | 1063583904 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 12/08/2009 |
| Medicare PECOS PAC ID | 3678518529 |
|---|---|
| Medicare Enrollment ID | O20050622000414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063583904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS0004936 (Florida) | Primary |
| 207Q00000X | Family Medicine | OS0005348 (Florida) | Secondary |
| Provider Name | Debra S Albers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245215730 PECOS PAC ID: 5799737664 Enrollment ID: I20050218000596 |
| Provider Name | Howard Weaver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710962857 PECOS PAC ID: 0345287488 Enrollment ID: I20050411001068 |
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