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General NPI Number Information
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NPI Number | 1952333221
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Entity Type | Individual
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Provider Name | GERALD EDWARD WEAVER MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 176 1ST AVE N
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City | ILWACO
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State | WA
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Zip | 98624-9137
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Country | US
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Telephone | 360-642-3747
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Fax | 360-642-3361
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Provider Business Mailing Address
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Address Line | 176 1ST AVE N OCEAN BEACH MEDICAL CLINIC
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City | ILWACO
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State | WA
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Zip | 98624-9137
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Country | US
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Telephone | 360-642-3747
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Fax | 360-642-3361
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5731A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD60398142
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License Number State | WA
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