Provider Demographics
NPI:1861689200
Name:WEIR, MARY J (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:WEIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLOW CREEK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3652
Mailing Address - Country:US
Mailing Address - Phone:817-599-6387
Mailing Address - Fax:817-599-6378
Practice Address - Street 1:150 WILLOW CREEK DR STE 103
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-3652
Practice Address - Country:US
Practice Address - Phone:817-599-6387
Practice Address - Fax:817-599-6378
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17711363AM0700X
TXPA14826363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA177110Medicare PIN