Healthcare Provider Details

I. General information

NPI: 1922071844
Provider Name (Legal Business Name): CARL CRAIG VAN WEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 CLARK AVE
DUBLIN CA
94568-3036
US

IV. Provider business mailing address

2345 COUNTRY HILLS DR
ANTIOCH CA
94509-7319
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-1677
  • Fax: 925-875-0826
Mailing address:
  • Phone: 925-418-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG35889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberG35889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: