Healthcare Provider Details

I. General information

NPI: 1679526313
Provider Name (Legal Business Name): THEODORE PATRICK WEIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THEODORE PATRICK WEIS M.D.

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CLYDE DR
WALNUT CREEK CA
94598-3447
US

IV. Provider business mailing address

225 CLYDE DR
WALNUT CREEK CA
94598-3447
US

V. Phone/Fax

Practice location:
  • Phone: 925-279-2226
  • Fax: 925-279-2228
Mailing address:
  • Phone: 925-279-2226
  • Fax: 925-279-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC34090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC34090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: