Provider Demographics
NPI:1376796037
Name:WEEDMAN, JAMES BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:WEEDMAN
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 1:1600 ARKANSAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1681
Mailing Address - Country:US
Mailing Address - Phone:501-450-9131
Mailing Address - Fax:
Practice Address - Street 1:1600 ARKANSAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1681
Practice Address - Country:US
Practice Address - Phone:870-779-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90660Medicare UPIN