Provider Demographics
NPI:1629072053
Name:WESTON, JON-MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:JON-MARC
Middle Name:
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 1:2435 NW KLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1690
Mailing Address - Country:US
Mailing Address - Phone:541-672-2020
Mailing Address - Fax:541-673-8084
Practice Address - Street 1:2435 NW KLINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1690
Practice Address - Country:US
Practice Address - Phone:541-672-2020
Practice Address - Fax:541-673-8084
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17072207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024203Medicaid
OR024203Medicaid
ORR102773Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
ORC29383Medicare UPIN