Mark Weaver, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6063 Issued in AZ

Practice address

4425 E Agave Rd
Suite 148
Phoenix, AZ 85044-0619

Phone

(480) 704-7546

NPI assigned

May 12, 2015

Last updated

May 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aap Dermatology & Cosmetic Surgery, P.C.

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1174730147
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1801274600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 E AGAVE RD",
            "address_2": "SUITE 148",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850440619",
            "telephone_number": "480-704-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 E AGAVE RD",
            "address_2": "SUITE 148",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850440619",
            "telephone_number": "480-704-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "MARK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-12",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody R Weaver
• Daschelle C. Weaver, LPN
• Gayle Lynn Weaver, PT
• Heidi Marie Weaver, PT, DPT
• Kevin Weaver, PH.D.
• Gilbert T Webb II, THERAPY DIRECTOR
• James Howard Webb Jr., D.D.S.
• James Randy Webb, LPC, LMHC
• Kimberly Webb
• Leila Maria Webb, CST

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.