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General NPI Number Information
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NPI Number | 1023249042
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Entity Type | Organization
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Legal Business Name | PULMONARY ASSOCIATES OF NORTHWESTERN ARIZONA, PLLC
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 1791 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5648
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Country | US
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Telephone | 928-257-1864
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Fax | 928-855-0188
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Provider Business Mailing Address
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Address Line | PO BOX 838
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-0838
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Country | US
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Telephone | 928-257-1864
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Fax | 928-855-0188
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Authorized Official
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Title or Position | MEMBER
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Name | JEAN MARIE WEAVER
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Credential | MD
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Telephone | 928-257-1864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 33312
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 33312
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License Number State | AZ
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