Provider Demographics
NPI:1023121936
Name:MALONEY, RICHARD WEAVER (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WEAVER
Last Name:MALONEY
Suffix:
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 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 1115
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5738
Mailing Address - Country:US
Mailing Address - Phone:239-594-9100
Mailing Address - Fax:239-594-3054
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 1115
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5738
Practice Address - Country:US
Practice Address - Phone:239-594-9100
Practice Address - Fax:239-594-3054
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 62779207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26421Medicare ID - Type Unspecified
FLC29653Medicare UPIN