Provider Demographics
NPI:1154495430
Name:WEAVER, DALE JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:JOSEPH
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:ORTHOPEDIC SURGERY DEPARTMENT BAMC
Mailing Address - Street 2:3851 ROGER BROOKE DRIVE
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-916-6166
Mailing Address - Fax:210-916-1359
Practice Address - Street 1:ORTHOPEDIC SURGERY DEPARTMENT BAMC
Practice Address - Street 2:3851 ROGER BROOKE DRIVE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-6166
Practice Address - Fax:210-916-1359
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325907YNVLOtherIND PTAN
TXDO7546OtherRR GROUP
TXP01245126OtherRR IND
TX00115XOtherGROUP PTAN
TX8859NDOtherBCBS