MEDICARE: RICHARD J. WEILAND, JR., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15988	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023207677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J. WEILAND, JR., M.D.

Provider Business Mailing Address
First Line	:	1207 EVERGREEN CT
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2843
Country	:	US
Telephone Number	:	509-758-0006
Fax Number	:	509-758-2607

Provider Business Practice Location Address
First Line	:	1207 EVERGREEN CT
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2843
Country	:	US
Telephone Number	:	509-758-0006
Fax Number	:	509-758-2607

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER S WEILAND
Credential	:
Telephone Number	:	509-758-0006

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	12/11/2009

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