Basic Information
| Provider Information | |||||||||
| NPI: | 1407969231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WESTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | PHYSICIAN SUPPORT SERVICES, 2ND FLOOR | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6555 COYLE AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165363620 | ||||||||
| FaxNumber: | 9165363541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G67212 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3352636 | 01 | CA | CIGNA | OTHER | MCMG126600 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 000810342904 | 01 | CA | PHCS | OTHER | 1089835 | 01 | CA | GREAT WEST | OTHER | 4460351 | 01 | CA | AETNA | OTHER | 90037764 | 01 | CA | PACIFICARE | OTHER | 20066 | 01 | CA | INTERPLAN | OTHER | G67212 | 01 | CA | BLUE CROSS | OTHER | 46396 | 01 | CA | FIRST HEALTH | OTHER | 725812 | 01 | CA | UNITED HEALTHCARE | OTHER | 034772 | 01 | CA | HEALTH NET | OTHER |