Provider Demographics
NPI:1386691905
Name:WEIDIG, BROOKE H (PA-C)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:H
Last Name:WEIDIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23330 HIGHWAY 59 N STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4471
Mailing Address - Country:US
Mailing Address - Phone:281-359-3223
Mailing Address - Fax:281-359-2089
Practice Address - Street 1:23330 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4471
Practice Address - Country:US
Practice Address - Phone:281-359-3223
Practice Address - Fax:281-359-2089
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical