Healthcare Provider Details

I. General information

NPI: 1104804038
Provider Name (Legal Business Name): BRENT ROBERT WEED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 N WEST AVE
FRESNO CA
93711-4301
US

IV. Provider business mailing address

6730 N WEST AVE
FRESNO CA
93711-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-3000
  • Fax: 559-439-3004
Mailing address:
  • Phone: 559-439-3000
  • Fax: 559-439-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC208136
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number51390-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number51390-020
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC208136
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number47142
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number51390-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: