Provider Demographics
NPI:1871524181
Name:WEYER, DEBORAH ANNE (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:WEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 ST VINCENT'S WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8459
Mailing Address - Country:US
Mailing Address - Phone:904-602-4330
Mailing Address - Fax:904-602-4371
Practice Address - Street 1:1658 ST VINCENT'S WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8459
Practice Address - Country:US
Practice Address - Phone:904-602-4330
Practice Address - Fax:904-602-4371
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78720207QA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58539OtherBC
FLME78720OtherMEDICAL LICENSE
FL262598900Medicaid
FL262598900Medicaid
FL58539OtherBC
FLME78720OtherMEDICAL LICENSE
FLH79780Medicare UPIN