Healthcare Provider Details

I. General information

NPI: 1609861517
Provider Name (Legal Business Name): ANDREW HARVEY WEARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S COLORADO ST STE A-D
LOCKHART TX
78644
US

IV. Provider business mailing address

300 S COLORADO ST STE A-D
LOCKHART TX
78644-2700
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-9690
  • Fax: 512-398-3755
Mailing address:
  • Phone: 512-376-9690
  • Fax: 512-398-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: