MEDICARE: HAROLD GORDON WEEMS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	E2229	AR
2	207X00000X	Orthopaedic Surgery Physician	J6798	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1G2223	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P02599448	OTHER	TX	RR MCR
7	98164	OTHER		BCBS

General Provider Information

NPI Number	:	1225038383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD GORDON WEEMS JR. MD

Provider Business Mailing Address
First Line	:	2900 SAINT MICHAEL DR STE 401
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-5211
Country	:	US
Telephone Number	:	903-614-5383
Fax Number	:	903-614-5343

Provider Business Practice Location Address
First Line	:	2602 SAINT MICHAEL DR STE 302A
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2387
Country	:	US
Telephone Number	:	903-614-5016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	06/23/2021

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Directions to “ HAROLD GORDON WEEMS JR. MD” Practice Location

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