Provider Demographics
NPI:1225499684
Name:WEBER, HEATHER JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JEAN
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-470-2590
Mailing Address - Fax:405-470-0619
Practice Address - Street 1:9417 N COUNCIL RD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162
Practice Address - Country:US
Practice Address - Phone:405-470-2590
Practice Address - Fax:405-470-0619
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty