Provider Demographics
NPI:1134122062
Name:WEAVER, RODERIC CARTER (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERIC
Middle Name:CARTER
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MARKET ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2854
Mailing Address - Country:US
Mailing Address - Phone:415-904-6087
Mailing Address - Fax:415-904-2300
Practice Address - Street 1:575 MARKET ST
Practice Address - Street 2:STE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2854
Practice Address - Country:US
Practice Address - Phone:415-904-6087
Practice Address - Fax:415-904-2300
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine