Basic Information
| Provider Information | |||||||||
| NPI: | 1417902354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEYER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N C AVE | ||||||||
| Address2: | PO BOX 1327 | ||||||||
| City: | THERMOPOLIS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824432410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078648207 | ||||||||
| FaxNumber: | 3078649470 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N C AVE | ||||||||
| Address2: | |||||||||
| City: | THERMOPOLIS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824432410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078648207 | ||||||||
| FaxNumber: | 3078649470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7347A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 123460900 | 05 | WY | MEDICAID | P00436280 | 01 | WY | RAILROAD MEDICARE | OTHER | 112JCW06 | 01 | WY | WY CONTROLLED SUBSTANCE # | OTHER | WY7347A | 01 | WY | WY MEDICAIL LICENSE # | OTHER | BW7433321 | 01 | WY | DEA | OTHER |