Individual
DR. GERALD EDWARD WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
176 1ST AVE N, ILWACO, WA 98624-9137
(360) 642-3747
(360) 642-3361
Mailing address
176 1ST AVE N, OCEAN BEACH MEDICAL CLINIC, ILWACO, WA 98624-9137
(360) 642-3747
(360) 642-3361
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5731A
WY
208600000X
Surgery Physician
Primary
MD60398142
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952333221
—
WA
01
—
G000802400
GROUP MC PTAN G000802400
WA
Enumeration date
07/07/2006
Last updated
05/21/2020
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