Provider Demographics
NPI:1356324305
Name:WEAVER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
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 1:8333 N DAVIS HWY
Mailing Address - Street 2:MEDICAL CENTER CLINIC OCCUPATIONAL MEDICINE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8300
Mailing Address - Fax:850-474-8654
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8300
Practice Address - Fax:850-474-8654
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME285992083A0100X, 202C00000X, 2083P0500X
FLME0028599207Q00000X
AL7180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine