Healthcare Provider Details

I. General information

NPI: 1801884846
Provider Name (Legal Business Name): HARRY TALMADGE WEAVER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 COLLEGE AVE
LEVELLAND TX
79336-6507
US

IV. Provider business mailing address

3420 22ND PL
LUBBOCK TX
79410-1314
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-3141
  • Fax:
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH4784
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: