Provider Demographics
NPI:1467444307
Name:WEEBER, STEPHEN ADAMS (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ADAMS
Last Name:WEEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 FAR HILLS AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2353
Mailing Address - Country:US
Mailing Address - Phone:937-438-3338
Mailing Address - Fax:937-438-3353
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:STE 220
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2382
Practice Address - Country:US
Practice Address - Phone:937-438-3338
Practice Address - Fax:937-438-3353
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002641W213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978009Medicaid
OH0672872Medicare ID - Type Unspecified
OH0978009Medicaid