Provider Demographics
NPI:1891756524
Name:WEICK, RAYMOND M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:WEICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1390 US HIGHWAY 61
Mailing Address - Street 2:SUITE N1000
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-933-9300
Mailing Address - Fax:
Practice Address - Street 1:1390 US HIGHWAY 61
Practice Address - Street 2:SUITE N1000
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-933-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002014088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918365280Medicare PIN
MOI09076Medicare UPIN