Individual
DEWAYNE LYNN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8741
Mailing address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8741
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-14024
ID
207X00000X
Orthopaedic Surgery Physician
MD60798747
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265674071
—
ID
05
—
1265674071
—
WA
Enumeration date
03/26/2009
Last updated
10/16/2018
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