Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10314A | WY |
N | 207Q00000X | Family Doctor | MRM-1347 | ID |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 10314A | WY |
N | 207VX0000X | Obstetrician | 10314A | WY |
NPI | 1326487794 |
---|---|
Provider Name | Dr. Spencer R. Weston |
First Address | Evanston, WY 82930-9352 |
Second Address | Evanston, WY 82930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 01/04/2021 |