Active NPI
John Mark Weaver, DDS
- Dentist
- Odessa, TX
National Provider Identifier
1326128521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13821
- Practice address
- 2000 N Grandview Ave
Odessa, TX 79761 - Phone
- (432) 362-2202
- Fax
- (432) 362-0690
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13821 | TX | Primary |
Addresses
Primary practice location
2000 N Grandview Ave
Odessa, TX 79761
Mailing address
2000 N Grandview Ave
Odessa, TX 79761
Phone (432) 362-2202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 26, 2016 through Feb 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13821 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326128521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 N GRANDVIEW AVE",
"city": "ODESSA",
"state": "TX",
"postal_code": "79761",
"telephone_number": "432-362-2202",
"fax_number": "432-362-0690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 N GRANDVIEW AVE",
"city": "ODESSA",
"state": "TX",
"postal_code": "79761",
"telephone_number": "432-362-2202",
"fax_number": "432-362-0690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAVER",
"first_name": "JOHN",
"middle_name": "MARK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "13821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.