Individual
DR. ROBERT MICHAEL WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1146 EVELYN GANDY PKWY, PETAL, MS 39465
(601) 584-4309
(601) 584-4890
Mailing address
1146 EVELYN GANDY PKWY, PETAL, MS 39465-3947
(601) 584-4309
(601) 584-4890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12277
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120046
—
MS
Enumeration date
06/16/2006
Last updated
08/27/2020
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