Individual
MR. DALE JOSEPH WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
ORTHOPEDIC SURGERY DEPARTMENT BAMC, 3851 ROGER BROOKE DRIVE, FORT SAM HOUSTON, TX 78234
(210) 916-6166
(210) 916-1359
Mailing address
ORTHOPEDIC SURGERY DEPARTMENT BAMC, 3851 ROGER BROOKE DRIVE, FORT SAM HOUSTON, TX 78234
(210) 916-6166
(210) 916-1359
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01012
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00115X
GROUP PTAN
TX
01
—
325907YNVL
IND PTAN
TX
01
—
8859ND
BCBS
TX
01
—
DO7546
RR GROUP
TX
01
—
P01245126
RR IND
TX
Enumeration date
11/20/2006
Last updated
11/12/2019
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