Provider Demographics
NPI:1992786701
Name:WEAVER, ROBERT R III (M D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:WEAVER
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 CONSTITUTION PL NE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7640
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PL NE STE 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7640
Practice Address - Country:US
Practice Address - Phone:505-998-3096
Practice Address - Fax:505-998-3100
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME700612085R0202X
NMMD2005-00122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF2783OtherGROUP RR MEDICARE
FL31750OtherBCBS
FLCA6907OtherGROUP RR MEDICARE
FLP00352555OtherRR MEDICARE
NM32630531Medicaid
FLP00060370OtherRR MEDICARE
FL250915600Medicaid
FLDF2783OtherGROUP RR MEDICARE
FL31750OtherBCBS