Healthcare Provider Details

I. General information

NPI: 1780730366
Provider Name (Legal Business Name): JOHN S WEAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 HALE PKWY STE 340
DENVER CO
80220-4000
US

IV. Provider business mailing address

4600 HALE PKWY STE 340
DENVER CO
80220-4000
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-0900
  • Fax: 303-280-3858
Mailing address:
  • Phone: 303-280-0900
  • Fax: 303-280-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number062175
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0048688
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: