Provider Demographics
NPI:1477589547
Name:WEAVER, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:200 S OAKRIDGE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1794
Mailing Address - Country:US
Mailing Address - Phone:817-599-5518
Mailing Address - Fax:817-599-5538
Practice Address - Street 1:200 S OAKRIDGE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-1794
Practice Address - Country:US
Practice Address - Phone:817-599-5518
Practice Address - Fax:817-599-5538
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03672363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical