Provider Demographics
NPI:1417210063
Name:WEBER, JOEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROBERT
Last Name:WEBER
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 1:1001 E 17TH ST
Mailing Address - Street 2:APT 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6767
Mailing Address - Country:US
Mailing Address - Phone:425-894-7294
Mailing Address - Fax:
Practice Address - Street 1:1609 N WARREN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3761
Practice Address - Country:US
Practice Address - Phone:520-626-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73312207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR73312OtherARIZONA MEDICAL BOARD TRAINING LICENSE NUMBER