Provider Demographics
NPI:1811156227
Name:WEAVER, GRAHAM OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:OLIVER
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5602
Mailing Address - Country:US
Mailing Address - Phone:903-212-4763
Mailing Address - Fax:903-758-7081
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 5001
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-315-5733
Practice Address - Fax:903-315-3002
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST1909207V00000X
MS20765207V00000X
TXQ7614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology