Provider Demographics
NPI:1154311736
Name:MERIWETHER, ROBERT PRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PRESTON
Last Name:MERIWETHER
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:P.O. BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:4625 FALCONCREST DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7458
Practice Address - Country:US
Practice Address - Phone:270-441-0012
Practice Address - Fax:270-538-5305
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21261207T00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212616Medicaid
KY64212616Medicaid
KYP400017682Medicare PIN