Provider Demographics
NPI:1285631200
Name:WEAVER, LEWIS C (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:C
Last Name:WEAVER
Suffix:
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 1:13102 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2710
Mailing Address - Country:US
Mailing Address - Phone:509-928-0300
Mailing Address - Fax:509-922-9241
Practice Address - Street 1:13102 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2710
Practice Address - Country:US
Practice Address - Phone:509-928-0300
Practice Address - Fax:509-922-9241
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8199820Medicaid
WAF84425Medicare UPIN
WA000371171Medicare ID - Type Unspecified