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General NPI Number Information
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NPI Number | 1578645339
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Entity Type | Organization
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Legal Business Name | MARK A WEIGHT MD PC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 2355 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-523-0303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1432
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1432
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Country | US
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Telephone | 208-552-8770
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Fax | 208-523-2025
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A WEIGHT
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Credential | MD
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Telephone | 208-523-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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