Provider Demographics
NPI:1417135336
Name:WEIHERT, RICHARD DALE (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:WEIHERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 WILLOWS RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1668
Mailing Address - Country:US
Mailing Address - Phone:619-445-3399
Mailing Address - Fax:619-445-7976
Practice Address - Street 1:4058 WILLOWS RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1668
Practice Address - Country:US
Practice Address - Phone:619-445-3399
Practice Address - Fax:619-445-7976
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-18355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant