Provider Demographics
NPI:1861531980
Name:WEISER, RICHARD ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:WEISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DARDANELLI LANE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1419
Mailing Address - Country:US
Mailing Address - Phone:408-374-3950
Mailing Address - Fax:408-374-1970
Practice Address - Street 1:320 DARDANELLI LANE
Practice Address - Street 2:SUITE 22
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1419
Practice Address - Country:US
Practice Address - Phone:408-374-3950
Practice Address - Fax:408-374-1970
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C318740Medicare ID - Type Unspecified
A34749Medicare UPIN