Basic Information
| Provider Information | |||||||||
| NPI: | 1639267263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEATHERWAX | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2757 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928590757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149732650 | ||||||||
| FaxNumber: | 7149732655 | ||||||||
| Practice Location | |||||||||
| Address1: | 18952 MACARTHUR BLVD | ||||||||
| Address2: | # 103 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926121432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498331432 | ||||||||
| FaxNumber: | 9497055455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G58975 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.