Provider Demographics
NPI:1073565677
Name:WEBER, TERRI B (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:B
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 TUTT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3575
Mailing Address - Country:US
Mailing Address - Phone:719-380-6800
Mailing Address - Fax:719-380-6815
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3575
Practice Address - Country:US
Practice Address - Phone:719-380-6800
Practice Address - Fax:719-380-6815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01301480Medicaid
CO538258Medicare ID - Type Unspecified
CO01301480Medicaid