Provider Demographics
NPI:1154307916
Name:WEBER, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:WEBER
Suffix:
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 1:1687 E. DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-1571
Mailing Address - Country:US
Mailing Address - Phone:715-425-6701
Mailing Address - Fax:715-426-3994
Practice Address - Street 1:319 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2452
Practice Address - Country:US
Practice Address - Phone:715-425-6701
Practice Address - Fax:715-426-3994
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25917207V00000X
WI25180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN872367200Medicaid
WI30526300Medicaid
MN160002440Medicare PIN
MN872367200Medicaid
P00260625Medicare PIN