1255305041 NPI number — RICK MARCUS WEBER MD

Table of content: MALLORY A PLUNKETT AA (NPI 1972122448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255305041 NPI number — RICK MARCUS WEBER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
RICK
Provider Middle Name:
MARCUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255305041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1052 ROSS CLARK CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-699-3600
Provider Business Mailing Address Fax Number:
334-699-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1052 ROSS CLARK CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-699-3600
Provider Business Practice Location Address Fax Number:
334-699-3601
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  14006 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: ME62499 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00055592 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04979560 . This is a "MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 000466815B . This is a "GEORGIA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051515758 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055827300 . This is a "FLORIDA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51515758 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1723151 . This is a "MEDICAID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 103368600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com