Provider Demographics
NPI:1073517827
Name:WEBER, CARL G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 N 5TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-582-2690
Mailing Address - Fax:360-582-2691
Practice Address - Street 1:800 N 5TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-582-2690
Practice Address - Fax:360-582-2691
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2013-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00040818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6230157OtherCIGNA
WA7537336OtherAETNA US HEALTHCARE
WA1883652OtherUNITED HEALTHCARE
WA8931741OtherL&I CRIME VICTIMS
WA04358891702OtherKITSAP PHYSICIAN SERVICES
WA1115724Medicaid
WA2146037OtherFIRST HEALTH
WA5422WEOtherREGENCE BLUE SHIELD
WA0159039OtherWA LABOR & INDUSTRIES
WA04358891798382A03OtherTRICARE WPS
WA110242184OtherRAIL ROAD MEDICARE
WA8931741OtherL&I CRIME VICTIMS
WA5422WEOtherREGENCE BLUE SHIELD