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General NPI Number Information
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NPI Number | 1245143213
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Entity Type | Individual
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Provider Name | JACK MICHAEL WEIR III PSS, PRSS, RSPS
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Gender | Male
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 4004 WORTH ST APT 1105
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City | DALLAS
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State | TX
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Zip | 75246-1607
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Country | US
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Telephone | 214-521-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N CARROLL AVE APT 1105
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City | DALLAS
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State | TX
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Zip | 75246-4801
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Country | US
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Telephone | 945-324-3538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1914-1223
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License Number State | TX
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