Provider Demographics
NPI:1114946191
Name:WEAVER, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1621 S 2ND ST APT F
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5468
Mailing Address - Country:US
Mailing Address - Phone:909-215-1035
Mailing Address - Fax:626-457-9121
Practice Address - Street 1:1035 S PRAIRIE AVE STE 1
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-5273
Practice Address - Country:US
Practice Address - Phone:310-672-6500
Practice Address - Fax:310-672-6781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-04-15
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Provider Licenses
StateLicense IDTaxonomies
CAG35959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine