Healthcare Provider Details

I. General information

NPI: 1154500122
Provider Name (Legal Business Name): FRED WEILAND MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR ATT NUCLEAR MEDICINE
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

PO BOX 897
ROSEVILLE CA
95678-0897
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1291
  • Fax: 916-663-9912
Mailing address:
  • Phone: 916-781-1291
  • Fax: 916-663-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberG39050
License Number StateCA

VIII. Authorized Official

Name: DR. FREDERICK L. WEILAND
Title or Position: PRESIDENT
Credential: MD
Phone: 916-781-1291