Provider Demographics
NPI:1295717478
Name:WEYMAN, RICHARD L IV (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:WEYMAN
Suffix:IV
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 1:2222 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7546
Mailing Address - Country:US
Mailing Address - Phone:563-383-2686
Mailing Address - Fax:563-884-8144
Practice Address - Street 1:2222 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7546
Practice Address - Country:US
Practice Address - Phone:563-383-2686
Practice Address - Fax:563-884-8144
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31175207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0184267Medicaid
IA1238640OtherCSA
BW5964817OtherDEA
IA1238640OtherCSA
IA0184267Medicaid
G89089Medicare UPIN