Provider Demographics
NPI:1437117306
Name:WEIDNER, CAROL DAVENPORT (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DAVENPORT
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANNETTE
Other - Last Name:WEIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4275 LITTLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5600
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:817-516-8444
Practice Address - Street 1:4275 LITTLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5600
Practice Address - Country:US
Practice Address - Phone:817-516-8811
Practice Address - Fax:817-516-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0876207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F37083Medicare UPIN
TX8F6320Medicare PIN