Individual
MARY ELIZABETH WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1052 ROSS CLARK CIRCLE, DOTHAN, AL 36303
(334) 699-3600
(334) 699-3601
Mailing address
1052 ROSS CLARK CIRCLE, DOTHAN, AL 36303
(334) 699-3600
(334) 699-3601
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10454
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000303619D
—
GA
05
—
042556700
—
FL
05
—
051515759
—
AL
05
—
05781000
—
MS
05
—
1757306
—
LA
01
—
51515759
BLUE CROSS BLUE SHIELD
AL
01
—
P00055590
RAILROAD MEDICARE
—
Enumeration date
02/17/2006
Last updated
04/19/2017
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