| Weaver Family Practice | |
|
1612 31st Ave Gulfport MS 39501-2750 | |
| (228) 865-1453 | |
| (228) 865-1451 |
| Full Name | Weaver Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1612 31st Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Randy Robinson (ADMINISTRATOR) |
| Authorized Official Contact | 2288651453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Weaver Family Practice 1612 31st Ave Gulfport MS 39501-2750 Ph: (228) 865-1453 | Weaver Family Practice 1612 31st Ave Gulfport MS 39501-2750 Ph: (228) 865-1453 |
| NPI Number | 1801904156 |
|---|---|
| Provider Enumeration Date | 08/28/2006 |
| Last Update Date | 02/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801904156 | NPI | - | NPPES |
| CM1261 | Other | MS | RAILROAD MEDICARE |
| 9014378 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 14403 (Mississippi) | Primary |
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