Provider Demographics
NPI:1093796658
Name:MERIWETHER, PAUL O (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:O
Last Name:MERIWETHER
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 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:903-572-9494
Practice Address - Street 1:2320 HARTS BLUFF RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7453
Practice Address - Country:US
Practice Address - Phone:903-577-9355
Practice Address - Fax:903-434-7039
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114164002Medicaid
TXB24867Medicare UPIN
TX114164002Medicaid