Provider Demographics
NPI:1225038383
Name:WEEMS, HAROLD GORDON JR (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:GORDON
Last Name:WEEMS
Suffix:JR
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 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5383
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 302A
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2387
Practice Address - Country:US
Practice Address - Phone:903-614-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2229207X00000X
TXJ6798207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132097008Medicaid
TX1G2223OtherMEDICARE
AR136778001Medicaid
TX132097004Medicaid
OK200241380BMedicaid
TXP02599448OtherRR MCR
98164OtherBCBS