Individual
AUSTIN A WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2026 S JACKSON, JACKSONVILLE, TX 75766
(903) 586-5678
Mailing address
PO BOX 847522, DALLAS, TX 75284-7522
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F4659
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130272107
—
TX
01
—
8A9566
BCBS
TX
Enumeration date
02/23/2006
Last updated
10/14/2014
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