| Richard Weizenecker, M.d., P.a. | |
|
1297 Sw State Road 47 Lake City FL 32025-0484 | |
| (386) 752-4711 | |
| (386) 752-5075 |
| Full Name | Richard Weizenecker, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1297 Sw State Road 47, Lake City, Florida |
| Authorized Official Name and Position | Richard Albert Weizenecker (PRESIDENT) |
| Authorized Official Contact | 3867524711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Weizenecker, M.d., P.a. 1297 Sw State Road 47 Lake City FL 32025-0484 Ph: (386) 752-4711 | Richard Weizenecker, M.d., P.a. 1297 Sw State Road 47 Lake City FL 32025-0484 Ph: (386) 752-4711 |
| NPI Number | 1114351830 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 08/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114351830 | NPI | - | NPPES |
| 054014500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME13858 (Florida) | Primary |
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