Provider Demographics
NPI:1134130438
Name:WEICHT, FORD ROBERT
Entity Type:Individual
Prefix:
First Name:FORD
Middle Name:ROBERT
Last Name:WEICHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3043
Mailing Address - Country:US
Mailing Address - Phone:325-677-6219
Mailing Address - Fax:325-677-0129
Practice Address - Street 1:1701 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3043
Practice Address - Country:US
Practice Address - Phone:325-677-6219
Practice Address - Fax:325-677-0129
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00738363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00665549OtherRAILROAD MEDICARE
TX094750901Medicaid
TX87N487OtherBLUE CROSS
TXG3291Medicare UPIN