Basic Information
| Provider Information | |||||||||
| NPI: | 1568419513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIBLE | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1490 STONE HEDGE DR | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012990679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6908 PROVIDENCE PARK DR S | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516603490 | ||||||||
| FaxNumber: | 2516603491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12913 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.30419 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080154729 | 01 | MS | MEDICARE RR INDIVIDUAL | OTHER | 5266238 | 01 | MS | AETNA INDIVIDUAL | OTHER | 00119477 | 05 | MS | MEDICAID | 0130116 | 01 | MS | UNITED HEALTHCARE INDIVIDUAL | OTHER | 9015909 | 01 | MS | MEDICAID GROUP | OTHER |