Provider Demographics
NPI:1962473074
Name:WEEKS, JOHN ALDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALDEN
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4119
Mailing Address - Street 2:15230 LAKESHORE DRIVE, SUITE 101
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-4119
Mailing Address - Country:US
Mailing Address - Phone:707-994-7377
Mailing Address - Fax:707-994-9456
Practice Address - Street 1:15230 LAKESHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8107
Practice Address - Country:US
Practice Address - Phone:707-994-7377
Practice Address - Fax:707-994-9456
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-03-18
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Provider Licenses
StateLicense IDTaxonomies
CAG38230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47397Medicare UPIN
CAG382030Medicare PIN
00G38230Medicare ID - Type Unspecified