Provider Demographics
NPI:1043656952
Name:WEBER, JENNIFER NICHOLE (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-835-2300
Mailing Address - Fax:
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-835-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine