Provider Demographics
NPI:1619113834
Name:WEICHERT, RUDOLPH F III (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:F
Last Name:WEICHERT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUDOLPH
Other - Middle Name:FREDERICK
Other - Last Name:WEICHERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 RUE SAINT PETER
Mailing Address - Street 2:UNIT 111
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-833-1304
Mailing Address - Fax:504-834-1306
Practice Address - Street 1:501 RUE SAINT PETER
Practice Address - Street 2:UNIT 111
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-833-1304
Practice Address - Fax:504-834-1306
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.009092208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AW4341602OtherDEA #