Provider Demographics
NPI:1376520338
Name:WEBER, HEATHER A (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PAINE ST SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1154
Mailing Address - Country:US
Mailing Address - Phone:515-957-9740
Mailing Address - Fax:515-957-9746
Practice Address - Street 1:85 PAINE ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1154
Practice Address - Country:US
Practice Address - Phone:515-957-9740
Practice Address - Fax:515-957-9746
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3415463Medicaid
IA1415463Medicaid
IAP00239579OtherRR MEDICARE
IA1376520338Medicaid
IA2415463Medicaid
IA4415463Medicaid
IA1376520338Medicaid
IAP00239579OtherRR MEDICARE