Provider Demographics
NPI:1215202015
Name:DR. W. DERMATOLOGY
Entity Type:Organization
Organization Name:DR. W. DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYMOUR
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:281-395-7770
Mailing Address - Street 1:22028C HIGHLAND KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5859
Mailing Address - Country:US
Mailing Address - Phone:281-395-7770
Mailing Address - Fax:281-395-7775
Practice Address - Street 1:22028C HIGHLAND KNOLLS DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5859
Practice Address - Country:US
Practice Address - Phone:281-395-7770
Practice Address - Fax:281-395-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0346207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty