Provider Demographics
NPI:1467434977
Name:WEBER, ROGER A (MD, PA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 MARQUESAS CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5644 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3331
Practice Address - Country:US
Practice Address - Phone:941-922-9232
Practice Address - Fax:941-927-8332
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78576207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7882OtherMEDICARE GROUP #
FLD16683Medicare UPIN
FLU3307ZMedicare PIN