Provider Demographics
NPI:1285867200
Name:WEBER, KIMBERLY LEIGH (IDC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LEIGH
Last Name:WEBER
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSRON 5
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96601-2206
Mailing Address - Country:US
Mailing Address - Phone:619-437-8983
Mailing Address - Fax:
Practice Address - Street 1:MSRON 5
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96601-2206
Practice Address - Country:US
Practice Address - Phone:619-437-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman