MEDICARE: MR. ROBERT D WEAVER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	2892	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000210901	OTHER	OH	ANTHEMBCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760461784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT D WEAVER DPM

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS ROAD
Second Line	:	SUITE #104
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3425
Country	:	US
Telephone Number	:	440-442-3113
Fax Number	:	440-442-5137

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE #104
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-442-3113
Fax Number	:	440-442-5137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/03/2019

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Directions to “ MR. ROBERT D WEAVER DPM” Practice Location

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