Provider Demographics
NPI:1417061094
Name:WEBBER, IAN TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:TREVOR
Last Name:WEBBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 2ND ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9446
Mailing Address - Country:US
Mailing Address - Phone:530-747-2023
Mailing Address - Fax:
Practice Address - Street 1:3061 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4009
Practice Address - Country:US
Practice Address - Phone:415-292-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA809672084P0800X
MO20040127772084P0800X
MI0845762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry