Individual
JEREMY WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
207 W 3RD ST, THE DALLES, OR 97058-1734
(541) 296-5452
Mailing address
207 W 3RD ST, THE DALLES, OR 97058-1734
(541) 296-5452
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/20/2011
Last updated
10/21/2015
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