Provider Demographics
NPI:1760565063
Name:WEESNER, RUTH ANN (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:WEESNER
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 1:1414 ARLINGTON ST
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2643
Mailing Address - Country:US
Mailing Address - Phone:580-333-7337
Mailing Address - Fax:580-332-3881
Practice Address - Street 1:1414 ARLINGTON ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2643
Practice Address - Country:US
Practice Address - Phone:580-333-7337
Practice Address - Fax:580-332-3881
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK16267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100130860BMedicaid
OK201373495OtherTAX ID NUMBER