MEDICARE: RUTH ANN WEESNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	16267	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760565063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ANN WEESNER MD

Provider Business Mailing Address
First Line	:	1414 ARLINGTON ST
Second Line	:	SUITE 1700
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-333-7337
Fax Number	:	580-332-3881

Provider Business Practice Location Address
First Line	:	1414 ARLINGTON ST
Second Line	:	SUITE 1700
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-333-7337
Fax Number	:	580-332-3881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	04/26/2013

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Directions to “ RUTH ANN WEESNER MD” Practice Location

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