Healthcare Provider Details

I. General information

NPI: 1053351213
Provider Name (Legal Business Name): RICHARD D WEBER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 EAST CHEVES STREET
FLORENCE SC
29506-2616
US

IV. Provider business mailing address

506 E CHEVES ST P.O. BOX 1905
FLORENCE SC
29503-1905
US

V. Phone/Fax

Practice location:
  • Phone: 843-413-3100
  • Fax: 843-413-3197
Mailing address:
  • Phone: 843-413-3100
  • Fax: 843-413-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number64
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: