Provider Demographics
NPI:1841248408
Name:WEAVER, JOHN DUDLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DUDLEY
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 130
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4478
Mailing Address - Country:US
Mailing Address - Phone:830-990-6631
Mailing Address - Fax:830-990-1892
Practice Address - Street 1:405 S US HIGHWAY 281
Practice Address - Street 2:STE 101C
Practice Address - City:JOHNSON CITY
Practice Address - State:TX
Practice Address - Zip Code:78636-4950
Practice Address - Country:US
Practice Address - Phone:830-868-7800
Practice Address - Fax:830-992-2861
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG8495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133026802Medicaid
TX133026802Medicaid
TX481529YNQ4Medicare PIN