Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | A21531 | CA |
Y | 208D00000X | General Practice Physician | A21531 | CA |
NPI | 1033227467 |
---|---|
Provider Name | Dr. John C Weaver II |
First Address | Oakland, CA 94623-2210 |
Second Address | Oakland, CA 94606-3730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A22643 | (02) | CA |