Provider Demographics
NPI:1235157611
Name:WEEKS, ROGER DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DANA
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7620
Practice Address - Street 1:47 MARIA DR
Practice Address - Street 2:SUITE 814
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3560
Practice Address - Country:US
Practice Address - Phone:707-762-7328
Practice Address - Fax:707-762-0614
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24319207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243190Medicaid
00A243190Medicare ID - Type Unspecified
A23912Medicare UPIN