Provider Demographics
NPI:1437274925
Name:WEBER, BARBARA ALICE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ALICE
Last Name:WEBER
Suffix:
Gender:F
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:PO BOX 341
Mailing Address - Street 2:N639 SILVER CREEK CASCADE RD
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075
Mailing Address - Country:US
Mailing Address - Phone:920-994-9999
Mailing Address - Fax:920-994-9998
Practice Address - Street 1:N639 SILVER CREEK CASCADE RD
Practice Address - Street 2:
Practice Address - City:RANDOM LAKE
Practice Address - State:WI
Practice Address - Zip Code:53075
Practice Address - Country:US
Practice Address - Phone:920-994-9999
Practice Address - Fax:920-994-9998
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32420000Medicaid
WI32420000Medicaid