Healthcare Provider Details

I. General information

NPI: 1730136011
Provider Name (Legal Business Name): RONALD GENE WEAKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS CT STE 124
MODESTO CA
95355-2814
US

IV. Provider business mailing address

1401 SPANOS CT STE 124
MODESTO CA
95355-2814
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:
Title or Position:
Credential:
Phone: