Doctor Name: | JOHN WEATHERWAX |
NPI Number: | 1902943038 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 620 John Paul Jones Cir Portsmouth Naval Medical Center Medical Staff Services Portsmouth, VA - 237082111 |
Business Phone Number: | 7579537550 |
Business Fax Number: | |
Mailing Address: | 3809 Lamplighter Ct, PORTSMOUTH |
State: | VA |
Postal Code: | 237032271 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 07/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |