MEDICARE: DR. DONALD GREGORY WESTON III MD

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
1	207L00000X	Anesthesiology Physician	4301049265	MI
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	4301049265	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1992784722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD GREGORY WESTON III MD

Provider Business Mailing Address
First Line	:	640 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-3303
Country	:	US
Telephone Number	:	616-457-1064
Fax Number	:	616-957-1297

Provider Business Practice Location Address
First Line	:	3210 EAGLE RUN DR NE
Second Line	:	SUITE 100
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-7051
Country	:	US
Telephone Number	:	616-957-1200
Fax Number	:	616-957-1297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	05/31/2013

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