# MITCHELL ROSS WEAVER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1033191994
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 35-084264 | OH | — |
| 2086S0129X | Vascular Surgery Physician | 4301069776 | MI | Yes |

## Other

- **Enumeration date:** 11/16/2005
- **Last updated:** 03/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000329893 | ANTHEM BC/BS | OH |
| 05 | — | 2497463 | — | OH |
| 01 | — | 7030574 | AETNA PROVIDER ID\# | — |