Provider Demographics
NPI:1518104595
Name:WEAVER, JOHN EARLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EARLE
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 1:1760 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2836
Mailing Address - Country:US
Mailing Address - Phone:831-274-2464
Mailing Address - Fax:
Practice Address - Street 1:1760 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-2836
Practice Address - Country:US
Practice Address - Phone:831-274-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19828208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice