Individual
MARK A WEIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2355 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 523-0303
(208) 523-9815
Mailing address
PO BOX 1432, IDAHO FALLS, ID 83403-1432
(208) 552-8770
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
M9283
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M9283
ID
207XX0801X
Orthopaedic Trauma Physician
M9283
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807238300
—
ID
Enumeration date
10/20/2006
Last updated
06/17/2019
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