Healthcare Provider Details

I. General information

NPI: 1295829406
Provider Name (Legal Business Name): KARL WEAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W CHURCH ST
SANTA MARIA CA
93458-5006
US

IV. Provider business mailing address

PO BOX 12826
SAN LUIS OBISPO CA
93406-2826
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax: 805-348-1856
Mailing address:
  • Phone: 805-547-7752
  • Fax: 805-547-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG79773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: