Individual
JEFFREY G WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2790 MOSSIDE BLVD, SUITE 105, MONROEVILLE, PA 15146-2743
(412) 372-2277
(412) 373-2307
Mailing address
2790 MOSSIDE BLVD, SUITE 105, MONROEVILLE, PA 15146-2743
(412) 372-2277
(412) 373-2307
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS004202L
PA
207ND0101X
MOHS-Micrographic Surgery Physician
OS004202L
PA
207NS0135X
Procedural Dermatology Physician
OS004202L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010428650006
—
PA
01
—
070012504
TRAV. MEDICARE
PA
01
—
097240
BLUESHIELD
PA
Enumeration date
08/24/2005
Last updated
05/27/2022
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