Provider Demographics
NPI:1467612572
Name:WEAVER, SHAUN (MD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 FM 1960 BYPASS RD W STE 101
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4019
Mailing Address - Country:US
Mailing Address - Phone:281-446-7173
Mailing Address - Fax:281-446-3841
Practice Address - Street 1:8901 FM 1960 BYPASS RD W STE 101
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4019
Practice Address - Country:US
Practice Address - Phone:281-446-7173
Practice Address - Fax:281-446-3841
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9085207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L15806Medicare PIN