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General NPI Number Information
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NPI Number | 1609086727
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE MEDICAL GROUP
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 1035 S PRAIRIE AVE STE. 1
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City | INGLEWOOD
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State | CA
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Zip | 90301-5272
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Country | US
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Telephone | 310-672-6500
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Fax | 310-672-6781
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Provider Business Mailing Address
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Address Line | 1035 S PRAIRIE AVE STE. 1
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City | INGLEWOOD
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State | CA
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Zip | 90301-5272
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Country | US
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Telephone | 310-672-6500
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Fax | 310-672-6781
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Authorized Official
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Title or Position | M.D.
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Name | DR. JOHN C. WEAVER
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Credential | M.D.
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Telephone | 310-672-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G35959
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License Number State | CA
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