Provider Demographics
NPI:1609851674
Name:EIDSON-TON, WETONA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:WETONA
Middle Name:SUZANNE
Last Name:EIDSON-TON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1260
Mailing Address - Country:US
Mailing Address - Phone:530-285-3205
Mailing Address - Fax:
Practice Address - Street 1:2051 JOHN JONES RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9701
Practice Address - Country:US
Practice Address - Phone:530-758-2060
Practice Address - Fax:916-734-5641
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609851674Medicaid