Provider Demographics
NPI:1326265919
Name:LAURENCE J.S. WEEKES M.D. AND LINDA TIGNER WEEKES, M.D. INC.
Entity Type:Organization
Organization Name:LAURENCE J.S. WEEKES M.D. AND LINDA TIGNER WEEKES, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:JS
Authorized Official - Last Name:WEEKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-577-7977
Mailing Address - Street 1:2650 JONES WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1203
Mailing Address - Country:US
Mailing Address - Phone:805-577-7977
Mailing Address - Fax:805-577-0745
Practice Address - Street 1:2650 JONES WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1203
Practice Address - Country:US
Practice Address - Phone:805-577-7977
Practice Address - Fax:805-577-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G284840Medicaid
CA00G284840Medicaid
CAA43750Medicare UPIN