Provider Demographics
NPI:1497711493
Name:WEIGHALL, ROXANE (DO)
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:
Last Name:WEIGHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ROXANE
Other - Middle Name:WEIGHALL
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3700 SOUTHERN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1265
Mailing Address - Country:US
Mailing Address - Phone:855-500-2873
Mailing Address - Fax:937-281-3992
Practice Address - Street 1:3700 SOUTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1265
Practice Address - Country:US
Practice Address - Phone:855-500-2873
Practice Address - Fax:937-281-3992
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007205208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000955123OtherANTHEM
OH2346198Medicaid
OH7900369OtherAETNA
OH000000955123OtherANTHEM
OH2346198Medicaid
OH000000955123OtherANTHEM