Individual
MATTHEW CALEB WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 S 23RD ST, BOISE, ID 83702-9100
(208) 345-1170
(208) 345-3502
Mailing address
211 16TH AVE N, NAMPA, ID 83687-4058
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/13/2015
Last updated
05/13/2015
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