Healthcare Provider Details

I. General information

NPI: 1396892162
Provider Name (Legal Business Name): JAMES BARRETT WEIDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 FOREST AVE STE 110
SAN JOSE CA
95128-4833
US

IV. Provider business mailing address

2186 BENTLEY RIDGE DR
SAN JOSE CA
95138-2421
US

V. Phone/Fax

Practice location:
  • Phone: 408-294-7725
  • Fax: 408-294-4442
Mailing address:
  • Phone: 408-294-7725
  • Fax: 408-294-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG60943
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG60943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: