Provider Demographics
NPI:1982134623
Name:ANDERSON, WESTON MARK (DO)
Entity type:Individual
Prefix:DR
First Name:WESTON
Middle Name:MARK
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:300 68TH STREET SE
Mailing Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-456-0842
Mailing Address - Fax:616-559-5864
Practice Address - Street 1:300 68TH STREET SE
Practice Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548
Practice Address - Country:US
Practice Address - Phone:616-456-0842
Practice Address - Fax:616-559-5864
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51510120402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry