Provider Demographics
NPI:1225492929
Name:WEAVER, KEVIN JR (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 MDG/JB ELMENDORF-RICHARDSON USAF
Mailing Address - Street 2:5955 ZEAMER AVE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99506-3702
Mailing Address - Country:US
Mailing Address - Phone:907-580-2908
Mailing Address - Fax:
Practice Address - Street 1:673 MDG/JBER USAF
Practice Address - Street 2:5955 ZEAMER AVE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99506
Practice Address - Country:US
Practice Address - Phone:075-802-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics