Provider Demographics
NPI:1316914872
Name:WEAVER, VICTOR J (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-382-1085
Mailing Address - Fax:
Practice Address - Street 1:7105 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3112
Practice Address - Country:US
Practice Address - Phone:520-547-0611
Practice Address - Fax:520-547-0616
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025541207Q00000X
AZ34072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ938920Medicaid
AZP00435438OtherRAILROAD MEDICARE
AZ106224Medicare ID - Type UnspecifiedMEDICARE#
AZH43331Medicare UPIN