Healthcare Provider Details

I. General information

NPI: 1992784722
Provider Name (Legal Business Name): DONALD GREGORY WESTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 EAGLE RUN DR NE SUITE 100
GRAND RAPIDS MI
49525-7051
US

IV. Provider business mailing address

640 44TH ST SW
GRANDVILLE MI
49418-3303
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-1200
  • Fax: 616-957-1297
Mailing address:
  • Phone: 616-457-1064
  • Fax: 616-957-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301049265
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number4301049265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: