Provider Demographics
NPI:1962062620
Name:WEAVER, PHILLIP ALEXANDER (MMSC, PA-C)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALEXANDER
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:520-742-9000
Mailing Address - Fax:
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3552
Practice Address - Country:US
Practice Address - Phone:520-545-0953
Practice Address - Fax:520-545-0954
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant