Provider Demographics
NPI:1508048661
Name:WEAVER MEDICAL PRACTICE, PA
Entity Type:Organization
Organization Name:WEAVER MEDICAL PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:HARRISBE
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:713-455-6962
Mailing Address - Street 1:3027 SUNRISE RUN LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1897
Mailing Address - Country:US
Mailing Address - Phone:713-455-6962
Mailing Address - Fax:713-330-4350
Practice Address - Street 1:902 NORMANDY ST STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4952
Practice Address - Country:US
Practice Address - Phone:713-455-6962
Practice Address - Fax:713-330-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6408261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031557401Medicaid