Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 15119 | SC |
NPI | 1053368266 |
---|---|
Provider Name | Jerome John Weems JR. |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0610131 | CIGNA ID (01) | SC |
110244173 | RR MEDICARE (01) | SC |
151196 | (05) | SC |
4350072 | AETNA ID (01) | SC |
576007863110 | BCBS OF SC ID (01) | SC |
576007863114 | BLUECHOICE HEALTHPLAN ID (01) | SC |
A99139 | (02) | SC |