NPI 1164928685 · live from the CMS NPI Registry
John Joseph Weaver, MD
Radiology, Diagnostic Radiology in Ketchikan, AK. National Provider Identifier 1164928685, active.
NPI record
| NPI | 1164928685 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 3100 Tongass Ave, Ketchikan, AK 99901 |
| Practice phone | 907-228-4644 |
| Mailing address | 4n199 Fox Mill Blvd, Saint Charles, IL 60175 |
| Enumerated | April 3, 2018 |
| Last updated | May 30, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology primary | 2085R0202X | 219179 (AK) |
| Radiology, Diagnostic Radiology | 2085R0202X | MD61549873 (WA) |
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.