MEDICARE: MELISSA WEAKLAND 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	207Q00000X	Family Medicine Physician	44393	WA

General Provider Information

NPI Number	:	1649245713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WEAKLAND MD

Provider Business Mailing Address
First Line	:	640 13TH WAY SW
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98020-4626
Country	:	US
Telephone Number	:	425-774-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	5416 BARNES AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3839
Country	:	US
Telephone Number	:	206-297-7678
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	01/15/2013

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