Healthcare Provider Details

I. General information

NPI: 1699973834
Provider Name (Legal Business Name): PENSACOLA RADIATION MEDICINE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 NORTH E STREET SUITE 134
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

1717 NORTH E STREET SUITE 134
PENSACOLA FL
32501-6339
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-2200
  • Fax: 850-469-5148
Mailing address:
  • Phone: 850-469-2200
  • Fax: 850-469-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH WILLIAM WEAVER
Title or Position: PRESIDENT
Credential: MD
Phone: 850-469-2200