Individual
THEODORE C WEATHERWAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-3557
Mailing address
2209 E 32ND ST, TACOMA, WA 98404-4922
(253) 593-0232
(253) 593-3311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MDRE.ML.60958797
WA
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
291350
MA
Other
Enumeration date
07/02/2019
Last updated
11/23/2022
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