Provider Demographics
NPI:1720427974
Name:WEAVER, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8121
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5060
Mailing Address - Fax:314-362-6959
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:STE 2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-362-5060
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2015013524208D00000X
UT12137545-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice