Weaver, Jack Eugene

Weaver, Jack Eugene is an individual health care provider with primary practice located at 209 S 36Th St , Muskogee OK 74401-5043. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Weaver, Jack Eugene can be contacted via phone (918) 682-7717.

Contact Information

Primary practice address
209 S 36Th St Muskogee OK 74401-5043
Phone: (918) 682-7717
Fax: (918) 682-9434
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 19721 Oklahoma
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 19721 Oklahoma
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 19721 Oklahoma

Profile Details

NPI number 1902802101
LBN Legal business name Weaver, Jack Eugene
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Apr 10th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902802101 NPPES
Oklahoma MEDICAID 100088830A
Oklahoma Other 1841508918

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