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NPI Code Detail

MEDICARE: ADAM M WEAVER PA-C

MEDICARE: ADAM M WEAVER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085-003865IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982928917
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM M WEAVER PA-C
Provider Business Mailing Address
First Line : 4301 WILSON STREET
Second Line : FCC
City : FORT SILL
State : OK
Zip : 73503
Country : US
Telephone Number : 580-558-8358
Fax Number :
Provider Business Practice Location Address
First Line : 4301 WILSON ST
Second Line :
City : LAWTON
State : OK
Zip : 73503-4472
Country : US
Telephone Number : 580-558-8358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2010
Last Update Date : 07/18/2023

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Directions to “ ADAM M WEAVER PA-C” Practice Location

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