Provider Demographics
NPI:1801884846
Name:WEAVER, HARRY TALMADGE JR (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:TALMADGE
Last Name:WEAVER
Suffix:JR
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 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:1804 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6507
Practice Address - Country:US
Practice Address - Phone:806-894-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4784208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J33ZOtherBLUE CROSS BLUE SHIELD
TX119654OtherSUPERIOR HEALTH PLAN
TX131443702Medicaid
TX126521102OtherFIRSTCARE
1416698OtherFIRST HEALTH CCN
4365823OtherAETNA
E04441Medicare UPIN
TX00J33ZMedicare ID - Type Unspecified