Basic Information
| Provider Information | |||||||||
| NPI: | 1871524181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEYER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1658 ST VINCENT'S WAY | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320688459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046024330 | ||||||||
| FaxNumber: | 9046024371 | ||||||||
| Practice Location | |||||||||
| Address1: | 1658 ST VINCENT'S WAY | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320688459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046024330 | ||||||||
| FaxNumber: | 9046024371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2014 | ||||||||
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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 | 207QA0000X | ME78720 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | 208000000X | ME78720 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 58539 | 01 | FL | BC | OTHER | ME78720 | 01 | FL | MEDICAL LICENSE | OTHER | 262598900 | 05 | FL | MEDICAID |