Healthcare Provider Details

I. General information

NPI: 1932167947
Provider Name (Legal Business Name): RANDALL P WEYRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 SEABIRD WAY
APOLLO BEACH FL
33572-3003
US

IV. Provider business mailing address

6602 SEABIRD WAY
APOLLO BEACH FL
33572-3003
US

V. Phone/Fax

Practice location:
  • Phone: 304-639-3427
  • Fax:
Mailing address:
  • Phone: 304-639-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number12455
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: