Healthcare Provider Details

I. General information

NPI: 1477556082
Provider Name (Legal Business Name): ROBERT MACHEL WEINACKER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST SUITE 100
MOBILE AL
36608-1753
US

IV. Provider business mailing address

3719 DAUPHIN ST SUITE 100
MOBILE AL
36608-1753
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5665
  • Fax: 251-414-5646
Mailing address:
  • Phone: 251-414-5665
  • Fax: 251-414-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11064
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11064
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: