Healthcare Provider Details

I. General information

NPI: 1982794533
Provider Name (Legal Business Name): MICHAEL F. WEAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 EAST RD BBSB 1222
HOUSTON TX
77054-6010
US

IV. Provider business mailing address

1941 EAST RD BBSB 1222
HOUSTON TX
77054-6010
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-2552
  • Fax: 713-486-2618
Mailing address:
  • Phone: 713-486-2558
  • Fax: 713-486-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101051584
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number44530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: