Individual
SIMON A WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 NE 92ND AVE, VANCOUVER, WA 98664-3225
(360) 514-2142
(360) 514-6820
Mailing address
PO BOX 5037, UNIT 282, PORTLAND, OR 97208-5037
(360) 514-2142
(360) 514-6820
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00040913
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278154
—
OR
05
—
8316747
—
WA
Enumeration date
06/05/2006
Last updated
09/25/2020
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