Provider Demographics
NPI:1639179088
Name:WEEDN, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:WEEDN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4611
Mailing Address - Country:US
Mailing Address - Phone:580-255-9111
Mailing Address - Fax:580-255-2246
Practice Address - Street 1:111 N 10TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4611
Practice Address - Country:US
Practice Address - Phone:580-255-9111
Practice Address - Fax:580-255-2246
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8843208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK022120752OtherRAILROAD MEDICARE
OK100104780AMedicaid