Provider Demographics
NPI:1134161359
Name:WEED, JOHN III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEED
Suffix:III
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:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-1010
Mailing Address - Country:US
Mailing Address - Phone:512-446-4500
Mailing Address - Fax:512-446-2063
Practice Address - Street 1:602 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2323
Practice Address - Country:US
Practice Address - Phone:512-446-4555
Practice Address - Fax:512-446-4533
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136298005Medicaid
TX50021402OtherDPS
TXAW5655608OtherDEA
TXAW5655608OtherDEA
TX136298005Medicaid