Individual
ADAM WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1330 ROCKEFELLER AVE STE 400, EVERETT, WA 98201-1676
(425) 261-4950
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01515
KS
363AM0700X
Medical Physician Assistant
—
MO
363AS0400X
Surgical Physician Assistant
Primary
PA60749442
WA
363AS0400X
Surgical Physician Assistant
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002153
MEDICARE PTAN
KS
05
—
200852150A
—
KS
Enumeration date
09/01/2010
Last updated
04/28/2021
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