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General NPI Number Information
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NPI Number | 1679774319
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Entity Type | Organization
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Legal Business Name | RONALD G WEAKLEY MD INC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1401 SPANOS CT #124
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-525-3883
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Fax | 209-525-3889
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Provider Business Mailing Address
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Address Line | 1401 SPANOS CT #124
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-525-3883
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Fax | 209-525-3889
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD GENE WEAKLEY
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Credential | MD
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Telephone | 209-525-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C36554
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License Number State | CA
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