Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 64 | SC |
NPI | 1053351213 |
---|---|
Provider Name | Richard D Weber |
First Address | Florence, SC 29503-1905 |
Second Address | Florence, SC 29506-2616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890814R | (05) | NC |
PD0644 | (05) | SC |
T23575 | (02) | SC |