Provider Demographics
NPI:1528118957
Name:WEAVER, BERT EVANS
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:EVANS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 BRUCE ST APT E
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2138
Mailing Address - Country:US
Mailing Address - Phone:801-776-0358
Mailing Address - Fax:
Practice Address - Street 1:2250 ROBINS DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-779-3001
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other