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: | |
Other - Suffix: | |
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: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 3536 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 3415463 | Medicaid | |
IA | 1415463 | Medicaid | |
IA | P00239579 | Other | RR MEDICARE |
IA | 1376520338 | Medicaid | |
IA | 2415463 | Medicaid | |
IA | 4415463 | Medicaid | |
IA | 1376520338 | Medicaid | |
IA | P00239579 | Other | RR MEDICARE |