Provider Demographics
NPI:1306848007
Name:WEBER, COLETTE S (DPM)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:S
Last Name:WEBER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S KIRKWOOD RD
Mailing Address - Street 2:STE. 208
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6169
Mailing Address - Country:US
Mailing Address - Phone:314-965-5371
Mailing Address - Fax:314-965-2228
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:STE. 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6169
Practice Address - Country:US
Practice Address - Phone:314-965-5371
Practice Address - Fax:314-965-2228
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000762213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66372Medicare UPIN
214340001Medicare PIN