Provider Demographics
NPI:1003851619
Name:JED P WEBER, M.D.,LLC
Entity Type:Organization
Organization Name:JED P WEBER, M.D.,LLC
Other - Org Name:COASTAL NEUROSURGERY & SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-734-9088
Mailing Address - Street 1:646 VIRGINIA ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6612
Mailing Address - Country:US
Mailing Address - Phone:727-734-9088
Mailing Address - Fax:727-210-1198
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-734-9088
Practice Address - Fax:727-210-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102790363AM0700X, 363AS0400X
FLPA2726363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0175OtherPTAN
FL49595Medicare ID - Type UnspecifiedJED
FLG26873Medicare UPIN
FLQ0175OtherPTAN
FLU1370ZMedicare ID - Type UnspecifiedRUDI
FLS65554Medicare UPIN
FLE1380UMedicare PIN