Provider Demographics
NPI:1477556082
Name:WEINACKER, ROBERT MACHEL III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MACHEL
Last Name:WEINACKER
Suffix:III
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 1:3719 DAUPHIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1753
Mailing Address - Country:US
Mailing Address - Phone:251-414-5665
Mailing Address - Fax:251-414-5646
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-414-5665
Practice Address - Fax:251-414-5646
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110642085R0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I925403OtherMEDICARE
AL51153175OtherBCBSAL
AL169178Medicaid
AL169178Medicaid
920003596OtherRAILROAD MEDICARE
VA242988OtherANTHEM BCBS
KY64046535Medicaid
VA920000079Medicare PIN