Organization
BLANCO REGIONAL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WEAVER MD (PRESIDENT)
(830) 833-5581
Entity
Organization
Contact information
Practice address
825 4TH ST, BLANCO, TX 78606-4913
(830) 833-5581
(830) 833-4933
Mailing address
PO BOX 1629, 825 FOURTH STREET, BLANCO, TX 78606-1629
(830) 833-5581
(830) 833-4933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080001301
—
TX
Enumeration date
03/21/2007
Last updated
06/16/2008
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