Provider Demographics
NPI:1760461784
Name:WEAVER, ROBERT D (DPM)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 WILSON MILLS ROAD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3425
Mailing Address - Country:US
Mailing Address - Phone:440-442-3113
Mailing Address - Fax:440-442-5137
Practice Address - Street 1:6551 WILSON MILLS RD
Practice Address - Street 2:SUITE #104
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3495
Practice Address - Country:US
Practice Address - Phone:440-442-3113
Practice Address - Fax:440-442-5137
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2892213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000210901OtherANTHEMBCBS
OH0257583Medicaid
OHP00093357Medicare PIN
OH000000210901OtherANTHEMBCBS
OH4040852Medicare PIN