MEDICARE: NATHAN CHAD WEAVER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	OT015752	PA

General Provider Information

NPI Number	:	1386064863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN CHAD WEAVER D.O.

Provider Business Mailing Address
First Line	:	2500 CANYON RD STE 1
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-444-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 CANYON RD STE 1
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-444-1491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	08/28/2020

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