Individual
MR. MICKEY RAY WEIMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.F.A.
Contact information
Practice address
323 E. RIVERSIDE DR #234, EAGLE, ID 83616
(208) 938-4080
(208) 938-8922
Mailing address
1963 W LONESOME DOVE ST, MERIDIAN, ID 83646-8271
(208) 724-6139
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
97391
ID
246ZS0410X
Surgical Technologist
97391
—
Other
Enumeration date
11/17/2006
Last updated
10/14/2014
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