Provider Demographics
NPI:1164625711
Name:AMMON D WEBER MD PLLC
Entity Type:Organization
Organization Name:AMMON D WEBER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-274-5131
Mailing Address - Street 1:100 S MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4020
Mailing Address - Country:US
Mailing Address - Phone:806-274-5131
Mailing Address - Fax:806-274-5132
Practice Address - Street 1:100 S MCGEE ST # S
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4020
Practice Address - Country:US
Practice Address - Phone:806-274-5131
Practice Address - Fax:806-274-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTM4646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188175701Medicaid
TX188175701Medicaid
TX00X692Medicare PIN