JACK T WEAVER DPM DO MD PA NPI 1063583904

NPI Information

  • NPI: 1063583904
  • Provider Name: JACK T WEAVER DPM DO MD PA
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 10D0867377
  • Address: 3120 CORRINE DR
    ORLANDO, FL
    ZIP 32803
  • Phone: (407) 894-1931

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NPI Details

JACK T WEAVER DPM DO MD PA is a family medicine in Orlando, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. JACK T WEAVER DPM DO MD PA NPI is 1063583904. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3120 CORRINE DR
ORLANDO, FL
ZIP 32803-206
Phone: (407) 894-1931
Fax: (407) 894-5919

The provider's authorized official is Howard D Weaver .
The authorized official title is Physician and has the following contact phone number (407) 894-1931.

The CLIA number assigned to this NPI record is 10D0867377 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/13/2006 and was last updated on 12/8/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineOS0005348FLORIDANo
2207Q00000XFamily MedicineOS0004936FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E31880MEDICARE UPINFLORIDA
2D60718MEDICARE UPINFLORIDA
3GROUP45796MEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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