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General NPI Number Information
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NPI Number | 1386064863
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Entity Type | Individual
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Provider Name | NATHAN CHAD WEAVER D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 2500 CANYON RD STE 1
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8624
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Country | US
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Telephone | 928-444-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 CANYON RD STE 1
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8624
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Country | US
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Telephone | 928-444-1491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OT015752
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License Number State | PA
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