Provider Demographics
NPI:1033513155
Name:WEYER, CHARLTON MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLTON
Middle Name:MORGAN
Last Name:WEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W LAKE ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4124
Mailing Address - Country:US
Mailing Address - Phone:970-237-8200
Mailing Address - Fax:970-237-8291
Practice Address - Street 1:1393 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6201
Practice Address - Country:US
Practice Address - Phone:575-758-8651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36138223Medicaid