Healthcare Provider Details

I. General information

NPI: 1679774319
Provider Name (Legal Business Name): RONALD G WEAKLEY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS CT #124
MODESTO CA
95355
US

IV. Provider business mailing address

1401 SPANOS CT #124
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-3883
  • Fax: 209-525-3889
Mailing address:
  • Phone: 209-525-3883
  • Fax: 209-525-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC36554
License Number StateCA

VIII. Authorized Official

Name: RONALD GENE WEAKLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 209-525-3883