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General NPI Number Information
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NPI Number | 1629309588
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Entity Type | Individual
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Provider Name | JOHN WILLIAM WEEDIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 6620 MAIN ST SUITE 1325, MS BCM 380
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City | HOUSTON
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State | TX
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Zip | 77030-2348
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Country | US
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Telephone | 713-798-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 DE SOTO AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6701
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Country | US
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Telephone | 713-798-4001
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A121212
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | BP20029578
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License Number State | TX
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