Provider Demographics
NPI:1629007968
Name:WEAVER, KEITH W (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 FULTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1229
Mailing Address - Country:US
Mailing Address - Phone:205-786-0315
Mailing Address - Fax:205-788-2663
Practice Address - Street 1:924 FULTON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1229
Practice Address - Country:US
Practice Address - Phone:205-786-0315
Practice Address - Fax:205-788-2663
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009769207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200004832OtherRAILROAD MEDICARE
AL000018378Medicaid
AL510-18378OtherBLUE CROSS OF ALABAMA
AL000018378Medicaid
AL000018378Medicare PIN
AL0499960002Medicare NSC