Individual
DICK WEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 W 4TH ST, ODESSA, TX 79761-5001
(432) 640-4000
(432) 640-4606
Mailing address
PO BOX 2129, ODESSA, TX 79760-2129
(432) 640-2408
(432) 640-4606
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP102271
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119937405
—
TX
Enumeration date
09/22/2006
Last updated
09/21/2016
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