Provider Demographics
NPI:1437192036
Name:WESTON, MARK CECIL (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CECIL
Last Name:WESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19255 SW 65TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7451
Mailing Address - Country:US
Mailing Address - Phone:503-208-9432
Mailing Address - Fax:503-673-1520
Practice Address - Street 1:19255 SW 65TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7451
Practice Address - Country:US
Practice Address - Phone:503-208-9432
Practice Address - Fax:503-673-1520
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22218207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288454Medicaid
OR288454Medicaid
ORR140323Medicare PIN