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Individual

JERE H WEAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
722 BANK ST NE, DECATUR, AL 35601-1610
(256) 351-1874
(256) 351-1876
Mailing address
722 BANK ST NE, DECATUR, AL 35601-1610
(256) 351-1874
(256) 351-1876

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
11631
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009912888
AL
01
01-12771
UNITED HEALTH
AL
01
010050478
MEDICARE RAILROAD RETIREE
AL
01
4585899
AETNA PROVIDER NUMBER
AL
01
51025264
BLUE CROSS PROVIDER NUMBE
AL
01
515-97711
BCBS
AL
Enumeration date
06/09/2005
Last updated
09/23/2013
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