Individual provider Active NPI

Grant Evans Weidler, LAC.

  • Acupuncturist
  • Magnolia, TX
National Provider Identifier
1154564888
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
Practice address
33300 Egypt LN Ste C700
Magnolia, TX 77354-2875
Phone
(281) 744-2040
Fax
(281) 617-4257
NPI assigned
Apr 10, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X Primary

Addresses

Primary practice location

33300 Egypt LN Ste C700
Magnolia, TX 77354-2875

Mailing address

33300 Egypt LN Ste C700
Magnolia, TX 77354-2875
Phone (281) 744-2040

Other identifiers 1

IdentifierTypeStateIssuer
AC01119OtherTXTEXAS MEDICAL BOARD/TEXAS BOARD OF ACUPUNCTURE EXAMINERS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hung Van Doan Acupuncturist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1154564888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33300 EGYPT LN STE C700",
            "city": "MAGNOLIA",
            "state": "TX",
            "postal_code": "773542875",
            "telephone_number": "281-744-2040",
            "fax_number": "281-617-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33300 EGYPT LN STE C700",
            "city": "MAGNOLIA",
            "state": "TX",
            "postal_code": "773542875",
            "telephone_number": "281-744-2040",
            "fax_number": "281-617-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDLER",
        "first_name": "GRANT",
        "middle_name": "EVANS",
        "name_prefix": "Mr.",
        "credential": "LAC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-10",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD/TEXAS BOARD OF ACUPUNCTURE EXAMINERS",
            "identifier": "AC01119",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Magnolia, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.