Provider Demographics
NPI:1528063997
Name:WEAVER, TERRY DEAN (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DEAN
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 1:602 1ST ST NE STE 1
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-2163
Mailing Address - Country:US
Mailing Address - Phone:605-539-1778
Mailing Address - Fax:
Practice Address - Street 1:602 1ST ST NE STE 1
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2163
Practice Address - Country:US
Practice Address - Phone:605-539-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3438207QG0300X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2018-0286OtherNMMB LICENSE