Individual
DR. ROBERT R. WEAVER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
8020 CONSTITUTION PL NE STE 202, ALBUQUERQUE, NM 87110-7640
(505) 998-3096
(505) 998-3100
Mailing address
8020 CONSTITUTION PL NE STE 202, ALBUQUERQUE, NM 87110-7640
(505) 998-3096
(505) 998-3100
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD2005-0012
NM
2085R0202X
Diagnostic Radiology Physician
ME70061
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250915600
—
FL
01
—
31750
BCBS
FL
05
—
32630531
—
NM
01
—
CA6907
GROUP RR MEDICARE
FL
01
—
DF2783
GROUP RR MEDICARE
FL
01
—
P00060370
RR MEDICARE
FL
01
—
P00352555
RR MEDICARE
FL
Enumeration date
11/09/2005
Last updated
10/11/2019
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