MEDICARE: DR. JOHN DUDLEY WEAVER 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	207Q00000X	Family Medicine Physician	G8495	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841248408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DUDLEY WEAVER MD

Provider Business Mailing Address
First Line	:	205 W WINDCREST ST
Second Line	:	STE 130
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4478
Country	:	US
Telephone Number	:	830-990-6631
Fax Number	:	830-990-1892

Provider Business Practice Location Address
First Line	:	405 S US HIGHWAY 281
Second Line	:	STE 101C
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4950
Country	:	US
Telephone Number	:	830-868-7800
Fax Number	:	830-992-2861

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/17/2017

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