Individual
MARK WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4425 E AGAVE RD, SUITE 148, PHOENIX, AZ 85044-0619
(480) 704-7546
Mailing address
4425 E AGAVE RD, SUITE 148, PHOENIX, AZ 85044-0619
(480) 704-7546
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6063
AZ
Other
Enumeration date
05/12/2015
Last updated
05/12/2015
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