10D0867377 CLIA NUMBER - JACK T WEAVER DPM DO MD PA

Laboratory Demographics

CLIA Number: 10D0867377

Facility Name: JACK T WEAVER DPM DO MD PA

Facility Address:
3120 CORRINE DR
ORLANDO, FL
ZIP 32803
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Facility Phone Number: 407 257-6100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063583904

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D0867377
LAB Type	Physician Office
Facility Name	JACK T WEAVER DPM DO MD PA
Street	3120 CORRINE DR
City	ORLANDO
State	FL
ZIP	32803
Phone	407 257-6100
CertificateType	4
CertificateEffectiveDate	2/25/2023
CertificateExpirationDate	2/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024