Individual
DR. MICHAEL JOHN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
775 POLE LINE RD W STE 203, TWIN FALLS, ID 83301-5820
(208) 814-8300
(208) 933-4909
Mailing address
660 S EUCLID AVE, C B 8121, SAINT LOUIS, MO 63110-1010
(314) 362-5060
(314) 362-6959
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
12137545-1205
UT
207RG0100X
Gastroenterology Physician
Primary
2271091
ID
208D00000X
General Practice Physician
2015013524
MO
Other
Enumeration date
06/20/2013
Last updated
01/09/2026
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