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General NPI Number Information
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NPI Number | 1114351830
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Entity Type | Organization
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Legal Business Name | RICHARD WEIZENECKER, M.D., P.A.
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1297 SW STATE ROAD 47
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City | LAKE CITY
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State | FL
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Zip | 32025-0484
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Country | US
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Telephone | 386-752-4711
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Fax | 386-752-5075
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Provider Business Mailing Address
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Address Line | 1297 SW STATE ROAD 47
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City | LAKE CITY
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State | FL
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Zip | 32025-0484
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Country | US
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Telephone | 386-752-4711
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Fax | 386-752-5075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD ALBERT WEIZENECKER
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Credential | M.D.
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Telephone | 386-752-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME13858
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License Number State | FL
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