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Individual

MR. DANE EDWARD WEATHERFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
IDC

Contact information

Practice address
10209 HOOPER ST, SAN DIEGO, CA 92124-3509
(860) 501-0511
Mailing address
10209 HOOPER ST, SAN DIEGO, CA 92124-3509
(860) 501-0511

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary

Other

Enumeration date
03/13/2012
Last updated
03/13/2012
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