Basic Information
| Provider Information | |||||||||
| NPI: | 1477556082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINACKER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MACHEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3719 DAUPHIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145665 | ||||||||
| FaxNumber: | 2514145646 | ||||||||
| Practice Location | |||||||||
| Address1: | 3719 DAUPHIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145665 | ||||||||
| FaxNumber: | 2514145646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 06/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 11064 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 174400000X | 11064 | AL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 102I925403 | 01 | AL | MEDICARE | OTHER | 51153175 | 01 | AL | BCBSAL | OTHER | 169178 | 05 | AL | MEDICAID |