Healthcare Provider Details

I. General information

NPI: 1841112620
Provider Name (Legal Business Name): ANTHONY LUKE WEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY WEAVER

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NE STUCKI AVE STE 230
HILLSBORO OR
97124-7328
US

IV. Provider business mailing address

7730 SW SPRUCE ST APT A
TIGARD OR
97223-8900
US

V. Phone/Fax

Practice location:
  • Phone: 503-869-8108
  • Fax:
Mailing address:
  • Phone: 503-863-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: