Healthcare Provider Details

I. General information

NPI: 1962473074
Provider Name (Legal Business Name): JOHN ALDEN WEEKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 LAKESHORE DR SUITE 101
CLEARLAKE CA
95422-8107
US

IV. Provider business mailing address

PO BOX 4119 15230 LAKESHORE DRIVE, SUITE 101
CLEARLAKE CA
95422-4119
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7377
  • Fax: 707-994-9456
Mailing address:
  • Phone: 707-994-7377
  • Fax: 707-994-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG38230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: