Organization
JACK E WEAVER, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK E WEAVER MD (OWNER)
(918) 682-7717
Entity
Organization
Contact information
Practice address
209 S 36TH ST, MUSKOGEE, OK 74401-5043
(918) 682-7717
(918) 682-9434
Mailing address
209 S 36TH ST, MUSKOGEE, OK 74401-5043
(918) 682-7717
(918) 682-9434
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088830A
—
OK
Enumeration date
09/22/2010
Last updated
08/25/2015
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