MEDICARE: DR. SEYMOUR MARCUS WEAVER III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	77612	WI
2	207N00000X	Dermatology Physician	C38690	CA
3	207N00000X	Dermatology Physician	F0346	TX

General Provider Information

NPI Number	:	1225126956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEYMOUR MARCUS WEAVER III MD

Provider Business Mailing Address
First Line	:	4801 WOODWAY DR STE 300E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1888
Country	:	US
Telephone Number	:
Fax Number	:	999-999-9999

Provider Business Practice Location Address
First Line	:	1411 E 31ST ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-1092
Country	:	US
Telephone Number	:	510-437-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/05/2025

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