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NPI Code Detail

MEDICARE: ROBERT LEONARD WIEBE M.D.

MEDICARE: ROBERT LEONARD WIEBE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA39033CA

General Provider Information

NPI Number : 1922049451
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LEONARD WIEBE M.D.
Provider Business Mailing Address
First Line : 39681 LARKSPUR PL
Second Line :
City : DAVIS
State : CA
Zip : 95616-9748
Country : US
Telephone Number : 530-753-6509
Fax Number :
Provider Business Practice Location Address
First Line : 201 WALNUT AVE
Second Line :
City : VALLEJO
State : CA
Zip : 94592-1107
Country : US
Telephone Number : 707-562-8350
Fax Number : 707-562-8369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/08/2007

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