Healthcare Provider Details

I. General information

NPI: 1023121936
Provider Name (Legal Business Name): RICHARD WEAVER MALONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD SUITE 1115
NAPLES FL
34110-5738
US

IV. Provider business mailing address

11181 HEALTH PARK BLVD SUITE 1115
NAPLES FL
34110-5738
US

V. Phone/Fax

Practice location:
  • Phone: 239-594-9100
  • Fax: 239-594-3054
Mailing address:
  • Phone: 239-594-9100
  • Fax: 239-594-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME 62779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: