Individual
BRIAN WEATHERDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1414 W FAIR AVE, STE 149, MARQUETTE, MI 49855-2675
(906) 228-7020
(906) 228-9371
Mailing address
1414 W FAIR AVE, STE 149, MARQUETTE, MI 49855-2675
(906) 228-7020
(906) 228-9371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001370
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601001370
STATE LICENSE
MI
Enumeration date
10/17/2006
Last updated
07/08/2007
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