Healthcare Provider Details

I. General information

NPI: 1295828457
Provider Name (Legal Business Name): ROBERT GLEN WEEKLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST ANESTHESIA DEPARTMENT
MOBILE AL
36617-2238
US

IV. Provider business mailing address

31655 ASHLEY CIR
SPANISH FORT AL
36527-4003
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7045
  • Fax:
Mailing address:
  • Phone: 251-626-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number34716
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: