Healthcare Provider Details

I. General information

NPI: 1831773100
Provider Name (Legal Business Name): DEVON WEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 HOLLYWOOD BLVD STE 447
HOLLYWOOD FL
33021-6947
US

IV. Provider business mailing address

1314 E LAS OLAS BLVD # 2105
FORT LAUDERDALE FL
33301-2334
US

V. Phone/Fax

Practice location:
  • Phone: 954-884-0077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: