Individual
JACK EUGENE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
209 S 36TH ST, MUSKOGEE, OK 74401-5043
(918) 710-4112
(918) 710-4118
Mailing address
4750 S GARNETT RD, TULSA, OK 74146-5222
(918) 710-4112
(918) 710-4118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
19721
OK
207Q00000X
Family Medicine Physician
19721
OK
208VP0014X
Interventional Pain Medicine Physician
Primary
19721
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088830A
—
OK
01
—
1841508918
GROUP NPI
OK
Enumeration date
06/22/2005
Last updated
02/04/2026
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