Provider Demographics
NPI:1346433976
Name:WEBER, ADAM WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:WALLACE
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14001 RIDGEDALE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1781
Mailing Address - Country:US
Mailing Address - Phone:952-473-0211
Mailing Address - Fax:952-473-7908
Practice Address - Street 1:916 SAINT PETER AVE
Practice Address - Street 2:#120
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2813
Practice Address - Country:US
Practice Address - Phone:763-230-2780
Practice Address - Fax:763-972-2230
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2017-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN52905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics