Provider Demographics
NPI:1093791576
Name:WEBER, LEONARD EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:EUGENE
Last Name:WEBER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SOUTH 205TH STREET
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022
Mailing Address - Country:US
Mailing Address - Phone:402-289-0854
Mailing Address - Fax:402-289-0854
Practice Address - Street 1:625 SOUTH 205TH STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-289-0854
Practice Address - Fax:402-289-0854
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE138012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068352000Medicaid
1300013607OtherRAILROAD MEDICARE
NE47 0683520 00Medicaid
IA0939397Medicaid
095287WEMedicare PIN
095827Medicare ID - Type Unspecified
D05144Medicare UPIN
D 05144Medicare UPIN