Provider Demographics
NPI:1952045585
Name:WEAVER, PRESTON (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 AUBURN ST APT 435
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1461
Mailing Address - Country:US
Mailing Address - Phone:571-789-5779
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:832-325-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program