Individual
JANE M WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 305, FORT WAYNE, IN 46845-1715
(260) 484-9611
(260) 484-1004
Mailing address
11141 PARKVIEW PLAZA DR STE 305, FORT WAYNE, IN 46845-1715
(260) 484-9611
(260) 484-1004
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01049799A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020041807
MEDICARE RAILROAD
IN
05
—
104435211
—
MI
05
—
200196440
—
IN
05
—
2107455
—
OH
Enumeration date
08/04/2005
Last updated
05/29/2009
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