Provider Demographics
NPI:1417170275
Name:WEIR, MICHAEL ROSS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:WEIR
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 1:2516 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3105
Mailing Address - Country:US
Mailing Address - Phone:254-742-2304
Mailing Address - Fax:254-742-0207
Practice Address - Street 1:2516 CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3105
Practice Address - Country:US
Practice Address - Phone:254-742-2304
Practice Address - Fax:254-742-0207
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF69286Medicare UPIN