Organization
JERE H. WEAVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERE H. WEAVER MD (MD/OWNER)
(256) 351-1874
Entity
Organization
Contact information
Practice address
722 BANK ST NE, DECATUR, AL 35601-1610
(256) 351-1874
(256) 351-1876
Mailing address
722 BANK ST NE, DECATUR, AL 35601-1610
(256) 351-1874
(256) 351-1876
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
11631
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912888
—
AL
01
—
51025264
BLUE CROSS PROVIDER NUMBE
AL
01
—
515-97711
BLUE CROSS BLUE SHIELD
AL
Enumeration date
12/03/2007
Last updated
09/23/2013
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