MEDICARE: DR. JON-MARC WESTON MD

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	207W00000X	Ophthalmology Physician	17072	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629072053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON-MARC WESTON MD

Provider Business Mailing Address
First Line	:	2435 NW KLINE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1690
Country	:	US
Telephone Number	:	541-672-2020
Fax Number	:	541-673-8084

Provider Business Practice Location Address
First Line	:	2435 NW KLINE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1690
Country	:	US
Telephone Number	:	541-672-2020
Fax Number	:	541-673-8084

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/09/2020

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