Provider Demographics
NPI:1508153750
Name:WEAVER, ROSE GONZALEZ (DO)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:GONZALEZ
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W NOPAL ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5210
Mailing Address - Country:US
Mailing Address - Phone:830-278-7101
Mailing Address - Fax:830-278-1465
Practice Address - Street 1:126 W NOPAL ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5210
Practice Address - Country:US
Practice Address - Phone:830-278-7101
Practice Address - Fax:830-278-1465
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ3484OtherLICENSE