Provider Demographics
NPI:1194815258
Name:WELLER, RICHARD DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVIS
Last Name:WELLER
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 1:319 W KINNEAR PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3732
Mailing Address - Country:US
Mailing Address - Phone:206-662-2847
Mailing Address - Fax:206-544-8326
Practice Address - Street 1:319 W KINNEAR PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3732
Practice Address - Country:US
Practice Address - Phone:206-662-2847
Practice Address - Fax:206-544-8326
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022858207R00000X
CAG30535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine