Provider Demographics
NPI:1922049451
Name:WIEBE, ROBERT LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEONARD
Last Name:WIEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39681 LARKSPUR PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9748
Mailing Address - Country:US
Mailing Address - Phone:530-753-6509
Mailing Address - Fax:
Practice Address - Street 1:201 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1107
Practice Address - Country:US
Practice Address - Phone:707-562-8350
Practice Address - Fax:707-562-8369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine