Provider Demographics
NPI:1801127154
Name:ROBERT J. WEEDN, M.D., INC.
Entity type:Organization
Organization Name:ROBERT J. WEEDN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-255-9111
Mailing Address - Street 1:111 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4667
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:73533-4667
Practice Address - Country:US
Practice Address - Phone:580-255-9111
Practice Address - Fax:580-255-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8843208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100104780AMedicaid
OK443409820001OtherBLUE CROSS BLUE SHIELD
022120752OtherRAILROAD MEDICARE
443409820Medicare PIN
OK443409820001OtherBLUE CROSS BLUE SHIELD