Provider Demographics
NPI:1326487794
Name:WESTON, SPENCER R (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:R
Last Name:WESTON
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 1:195 FEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9352
Mailing Address - Country:US
Mailing Address - Phone:307-200-9200
Mailing Address - Fax:307-200-4808
Practice Address - Street 1:195 FEATHER WAY
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930
Practice Address - Country:US
Practice Address - Phone:307-200-9200
Practice Address - Fax:307-200-4808
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-1347207Q00000X
WY10314A207QH0002X, 207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics