Provider Demographics
NPI:1083973416
Name:WEBER, STEVE N
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:N
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 65 BOX 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73770-9702
Mailing Address - Country:US
Mailing Address - Phone:580-430-6960
Mailing Address - Fax:866-843-7008
Practice Address - Street 1:403 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3636
Practice Address - Country:US
Practice Address - Phone:580-430-6960
Practice Address - Fax:866-843-7008
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)