Individual
JEREMY BLAKE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
620 BROADWAY ST, VAN BUREN, AR 72956-5830
(479) 474-5061
(479) 922-2007
Mailing address
620 BROADWAY ST, VAN BUREN, AR 72956-5830
(479) 474-5061
(479) 922-2007
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-843
AR
363A00000X
Physician Assistant
PA06492
TX
Other
Enumeration date
12/09/2009
Last updated
01/26/2021
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