Provider Demographics
NPI:1053351213
Name:WEBER, RICHARD D (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E CHEVES ST
Mailing Address - Street 2:P.O. BOX 1905
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-1905
Mailing Address - Country:US
Mailing Address - Phone:843-413-3100
Mailing Address - Fax:843-413-3197
Practice Address - Street 1:506 EAST CHEVES STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2616
Practice Address - Country:US
Practice Address - Phone:843-413-3100
Practice Address - Fax:843-413-3197
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890814RMedicaid
SCPD0644Medicaid
SCT23575Medicare UPIN