Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9840 | TX |
NPI | 1053335331 |
---|---|
Provider Name | Lloy Harrell Weaver |
First Address | Willis, TX 77378 |
Second Address | The Woodlands, TX 77381-4912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |